Potential Drug Interactions among Medical Intensive Care Unit Patients at a Private Hospital in Central Java, Indonesia
Article Sidebar
Main Article Content
Page: 2732-2740
Abstract
Potential drug–drug interactions (pDDIs) are a major cause of medication-related problems in critically ill patients; however, evidence from intensive care units (ICUs) in Indonesia remains limited. This prospective cross-sectional study aimed to evaluate the prevalence, severity, and predictors of pDDIs among 100 patients admitted to the ICU of Kendal Islamic Hospital, Central Java, Indonesia, from June to July 2025. Medication data were extracted from electronic medical records and systematically screened using the DrugBank® database. Descriptive analysis, chi-square test, and binary logistic regression were performed. All patients experienced at least one pDDI, with a total of 4,938 pDDIs involving 50 distinct drug pairs. Moderate-severity interactions predominated (66.5%), followed by minor (23.4%) and major (10.1%) interactions, with the severity distribution differing significantly (χ² = 2,577.38; p < 0.001). Fentanyl–ranitidine was the most frequently identified drug pair. Binary logistic regression identified age category as the only independent predictor of major pDDIs (OR = 3.531; 95% CI 1.564–7.975; p = 0.003), whereas sex and ICU length of stay were not significantly associated. These findings demonstrate the high burden of pDDIs among ICU patients and highlight the need for systematic pDDI screening and greater involvement of clinical pharmacists to improve medication safety.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
Patel N, Desai M, Shah S, Patel P, Gandhi A. A study of potential drug–drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. J Basic Clin Pharm. 2014;5(2):44–48. DOI: https://doi.org/10.4103/0976-0105.134983
Baniasadi S, Farzanegan B, Alehashem M. Important drug classes associated with potential drug–drug interactions in critically ill patients: highlights for cardiothoracic intensivists. Ann Intensive Care. 2015;5(1):44. DOI: https://doi.org/10.1186/s13613-015-0086-4
Murni IK, Duke T, Kinney S, Daley AJ, Soenarto Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child. 2015;100(5):454–459. DOI: https://doi.org/10.1136/archdischild-2014-307297
Crucetta DFA, Bravim ID, Dal Col AJ, Zandonade E, Pereira ML. Potential drug–drug interactions in a Brazilian intensive care unit. Rev Bras Ter Intensiva. 2022;34(4):447–456.
Hammes JA, Pfuetzenreiter F, da Silveira F, Koenig A, Westphal GA. Potential drug interactions prevalence in intensive care units. Rev Bras Ter Intensiva. 2008;33(1):36–41.
Reis AMM, Cassiani SHDB. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics. 2011;66(1):9–15. DOI: https://doi.org/10.1590/S1807-59322011000100003
Fitzmaurice MG, Wong A, Akerberg H, Avber S, Tso G, Shugarts S, et al. Evaluation of potential drug–drug interactions in adults in the emergency department: a systematic review and meta-analysis. J Emerg Med. 2019;56(1):29–43.
Vanham D, Spinewine A, Hantson P, Wittebole X, Wouters D, Sneyers B. Drug–drug interactions in the intensive care unit: do they really matter? J Crit Care. 2017;38:97–103. DOI: https://doi.org/10.1016/j.jcrc.2016.09.014
Zheng WY, Richardson LC, Li L, Day RO, Westbrook JI, Baysari MT. Drug–drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2018;74(1):15–27. DOI: https://doi.org/10.1007/s00228-017-2357-5
Uijtendaal EV, van Harssel LLM, Hugenholtz GWK, Kuck EM, Zwart-van Rijkom JEF, Cremer OL, et al. Analysis of potential drug–drug interactions in medical intensive care unit patients. Pharmacotherapy. 2014;34(3):213–219. DOI: https://doi.org/10.1002/phar.1395
Jankovic SM, Pejcic AV, Milosavljevic MN, Opancina VD, Pesic NV, Nedeljkovic TT, et al. Risk factors for potential drug–drug interactions in intensive care unit patients. J Crit Care. 2018;43:1–6. DOI: https://doi.org/10.1016/j.jcrc.2017.08.021
Roblek T, Vaupotic T, Mrhar A, Lainscak M. Drug–drug interaction software in clinical practice: a systematic review. Eur J Clin Pharmacol. 2015;71(2):131–142. DOI: https://doi.org/10.1007/s00228-014-1786-7
Palleria C, Di Paolo A, Giofre C, Caglioti C, Leuzzi G, Siniscalchi A, et al. Pharmacokinetic drug–drug interaction and their implication in clinical management. J Res Med Sci. 2013;18(7):601–610.
Savarino V, Marabotto E, Zentilin P, Furnari M, Bodini G, De Maria C, et al. Proton pump inhibitors: use and misuse in the clinical setting. Expert Rev Clin Pharmacol. 2018;11(11):1123–1134. DOI: https://doi.org/10.1080/17512433.2018.1531703
Scarpignato C, Gatta L, Zullo A, Blandizzi C. Effective and safe proton pump inhibitor therapy in acid-related diseases: a position paper addressing benefits and potential harms of acid suppression. BMC Med. 2016;14(1):179. DOI: https://doi.org/10.1186/s12916-016-0718-z
Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306. DOI: https://doi.org/10.1097/CCM.0b013e3182783b72
Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825–e873. DOI: https://doi.org/10.1097/CCM.0000000000003298
Lee H, Ryu K, Sohn Y, Kim J, Suh GY, Kim E. Impact on patient outcomes of pharmacist participation in multidisciplinary critical care teams: a systematic review and meta-analysis. Crit Care Med. 2019;47(9):1243–1250. DOI: https://doi.org/10.1097/CCM.0000000000003830
Foong AL, Patel T, Kellar J, Grindrod KA. The scoop on serotonin syndrome. Can Pharm J. 2018;151(4):233–239. DOI: https://doi.org/10.1177/1715163518779096
Czock D, Keller F, Rasche FM, Haussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44(1):61–98. DOI: https://doi.org/10.2165/00003088-200544010-00003
Moura CS, Acurcio FA, Belo NO. Drug–drug interactions associated with length of stay and cost of hospitalization. J Pharm Pharm Sci. 2009;12(3):266–272. DOI: https://doi.org/10.18433/J35C7Z
Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14. DOI: https://doi.org/10.1046/j.1365-2125.2003.02007.x
Carvalho REFL, Reis AMM, de Faria LMP, Zago KSA, Cassiani SHDB. Prevalence of drug interactions in intensive care units in Brazil. Acta Paul Enferm. 2013;26(2):150–157. DOI: https://doi.org/10.1590/S0103-21002013000200008
Plaza J, Alamo M, Torres P, Fuentes A, Lopez F. Drug interactions and adverse events induced by drugs used in an intensive care unit. Rev Med Chil. 2020;138(4):452–460.
Askari M, Eslami S, Louws M, Wierenga PC, Dongelmans DA, Kuiper RA, et al. Frequency and nature of drug–drug interactions in the intensive care unit. Pharmacoepidemiol Drug Saf. 2018;22(4):430–437. DOI: https://doi.org/10.1002/pds.3415
Lima REF, De Bortoli Cassiani SH. Potential drug interactions in intensive care patients at a teaching hospital. Rev Lat Am Enfermagem. 2009;17(2):222–227. DOI: https://doi.org/10.1590/S0104-11692009000200013
Kheshti R, Aalipour M, Namazi S. A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness. J Res Pharm Pract. 2016;5(4):257–263. DOI: https://doi.org/10.4103/2279-042X.192461
Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm. Crit Care. 2017;14(5):R174. DOI: https://doi.org/10.1186/cc9278
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. DOI: https://doi.org/10.1186/s12877-017-0621-2
Van Leeuwen RWF, Brundel DHS, Neef C, van Gelder T, Mathijssen RHJ, Burger DM, et al. Prevalence of potential drug–drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer. 2015;108(5):1071–1078. DOI: https://doi.org/10.1038/bjc.2013.48
Hidayati NR, Susilo R, Anggraeni M. Kajian potensi interaksi obat pada pasien gagal ginjal rawat jalan RS "X" Kota Cirebon. Pharmacon: Jurnal Farmasi Indonesia. 2020;17(2):157–164. DOI: https://doi.org/10.23917/pharmacon.v17i2.12948
Zulfa FQ, Mutmainah N. Potensi interaksi obat pada pasien diabetes mellitus tipe 2 dengan komplikasi di instalasi rawat inap rumah sakit. Usadha: Journal of Pharmacy. 2025;4(3):238–248.