Potential drug interactions are a common risk for pediatric patients, according to a recent study in the journal Pediatrics.
The study, released Dec. 15, examined 498,956 hospitalizations of pediatric patients less than 21 years old at U.S. childrens hospitals. Researchers discovered exposure to major drug to drug interactions occurs in 41% of pediatric hospitalizations. Pediatric patients often are exposed to several distinct medications, with counts exceeding 25 unique medications for youngsters with longer hospital stays or rare conditions, the study said.
Known as polypharmacy, the concurrent use of multiple medications has been shown to put pediatric patients in danger of developing medication-related drug events from medication interactions, the study said. Off-label prescribing of medications, lack of therapeutic profiles for rarer drugs and weight-based dosing schemes make children particularly vulnerable to potential drug to drug interactions, or PDDIs, according to the study.
Among the most common adverse effects were additive respiratory depression, bleeding risk, reduced iron absorption/availability, central nervous system depression, hyperkalemia and altered diuretic effectiveness. Medications commonly involved in potential drug to drug interactions included opioids, antiinfective agents, neurologic agents, gastrointestinal agents, and cardiovascular agents, the study said.
For contraindicated pairs, exposure to ibuprofen and ketorolac occurred in 1.8% of hospitalizations, with fluconazole and ondansetron at 0.9% and calcium chloride and ceftriaxone 0.7%. Among pairs with major interactions, fentanyl and morphine occurred in 13.2% of hospitalizations, followed by fentanyl and midazolam at 11.2%, midazolam and morphine at 9.2%, and bupivacaine and proposal at 5.8%, the study stated.
Research also showed the likelihood of potential drug to drug interaction increased over the course of hospitalizations and that patterns varied by patient age, with 21.8% of infants being exposed on hospital day one and 32% of infants exposed by hospital day 30. The Institute of Medicine has named medication safety in children and the recognition and prevention of adverse drug effects as a high priority for healthcare.
Hospitalized patients are commonly exposed to PDDIs, but the subsequent probability of occurrence and magnitude of patient harm requires further empirical substantiation, the researchers concluded. Less common PDDIs represent the majority of all PDDI exposures, and these less common PDDIs may provide a high-yield target to improve patient safety.
Read the study at http://pediatrics.aappublications.org/content/early/2014/12/09/peds.2014-2015.abstract.