Drug-drug interactions in the intensive care unit: Do they really matter?

Purpose: To describe prevalence and patterns of potential drug-drug interactions (pDDIs) in the intensive care unit (ICU), occurrence of adverse drug events (ADEs), and agreement between different compendia and intensivists' perceptions. Methods: A cross-sectional study. Drug profiles of all adult patients from2 academic ICUs were screened on day 3 upon admission. We identified pDDIs using 3 compendia (Stockley's, Micromedex, and Epocrates) and documented their mechanism of action, clinical onsequences, severity, level of evidence, and management. Medical recordswere searched to identifyADEs potentially related tomajor pDDIs. Agreement between information sources (compendia, intensivists) was evaluated. Results: We identified 1120 pDDIs among 275 patients. Median number of pDDIs per patient was 3.0 (interquartile range, 1-6), with 79% of patients presenting with at least 1 pDDI. Major pDDIs were detected in 18% of patients, with potentially related to ADEs in 4% of patients. Only 13% of all pDDIs were documented simultaneously in all 3 compendia. Different information sources (compendia, clinicians) showed “no” to “fair” agreement. Conclusions: Potential drug-drug interactions occurred inmost ICU patients, contrastingwith lowrates of potentially related ADEs, which may have been underestimated. Sources of information are inconsistent, challenging the identification of pDDIs.