Dahiliye Yoğun Bakım Hastalarında Potansiyel İlaç Etkileşimlerinin, Farklı Veri Tabanları Kullanılarak Karşılaştırmalı Olarak İncelenmesi

Yıl 2025, Cilt: 51 Sayı: 3, 419 - 426, 08.12.2025

Ahmet Özyürek , Murat Aysin , İsmail Yılmaz , Ali Yıldırım

Öz

İlaç etkileşimleri, yoğun bakım ünitelerinde sıkça karşılaşılan önemli bir sağlık sorunudur. Çalışmamızın amacı, daha güncel veriler elde etmek ve ilaç etkileşimleri konusunda farkındalığı artırmaktır. 2019 yılında yoğun bakım ünitesine yatışı yapılan 163 hastanın verileri retrospektif olarak analiz edildi. Hastaların ilaç listeleri günlük bazda değerlendirildi ve üç farklı çevrimiçi veri tabanı kullanılarak ilaç bilgileri analiz edildi. Toplam 1.834 ilaç reçetesi incelendi. En sık yatış tanıları pnömoni, akut böbrek yetmezliği ve gastrointestinal kanama idi. Eşlik eden hastalık sayısı ve ilaç sayısı arttıkça etkileşim sayısı anlamlı şekilde arttı. Bu ilişki özellikle kardiyovasküler hastalıklar için belirgindi. Etkileşim sayısı erkeklerde daha yüksekti. Etkileşimler Micromedex’te reçetelerin %82,9’unda, Lexicomp’ta %92,5’inde ve Drugs.com’da %95,5’inde tespit edildi. En sık kontrendike etkileşim linezolid ile tramadol arasında, en sık majör etkileşim ise aspirin ile enoksaparin arasında görüldü. İlaç etkileşimlerinin değerlendirilmesi, hasta sonuçlarının iyileştirilmesine ve gereksiz ekonomik yükün önlenmesine yol açabilir. Klinik hekimler bu değerlendirmeleri yaparken birden fazla kaynaktan yararlanmalıdır. Veri tabanları arasında önemli farklılıklar mevcuttur.

Anahtar Kelimeler

İlaç etkileşimleri , yoğun bakım , polifarmasi , veri tabanları

Comparative Evaluation of Potential Drug Interactions in Internal Medicine Intensive Care Unit Patients Using Different Databases

Öz

Drug interactions are a significant healthcare concern frequently encountered in intensive care units. Our study aims to acquire more up-to-date data and raise awareness of drug interactions. A retrospective analysis was performed on the data of 163 patients admitted to the intensive care unit in 2019. The patients' medication lists were evaluated on a daily basis, and drug information was analyzed using three different online databases, and1,834 medication orders were analyzed. The most common admission diagnoses were pneumonia, acute renal failure, and gastrointestinal bleeding. The number of interactions increased significantly with increasing comorbidities and number of drugs. This association was particularly evident for cardiovascular diseases. The number of interactions was higher in men. Interactions were identified in 82.9% of orders in Micromedex, 92.5% in Lexicomp, and 95.5% in Drugs.com. The most common contraindicated interaction was between linezolid and tramadol, while the most common major interaction was between aspirin and enoxaparin. Assessment of drug interactions can lead to improved patient outcomes and avoidance of unnecessary economic burden. Clinicians should use several sources when performing such assessments. There are significant differences between the databases.

Anahtar Kelimeler

Drug Interactions , Intensive Care , Polypharmacy , Databases

Kaynakça

• 1. Borda IT, Slone D, Jick H. Assessment of Adverse Reactions Within a Drug Surveillance Program. JAMA. 1968;205(9):645-647. doi:10.1001/JAMA.1968.03140350055016
• 2. Costa AJ. Potential Drug Interactions in an Ambulatory Geriatric Population. Fam Pract. 1991;8(3):234-236. doi:10.1093/FAMPRA/8.3.234
• 3. Preventable Adverse Drug Reactions: A Focus on Drug Interactions | FDA. Accessed June 12, 2023. https://www.fda.gov/drugs/drug-interactions-labeling/preventable-adverse-drug-reactions-focus-drug-interactions
• 4. Karas S. The potential for drug interactions. Ann Emerg Med. 1981;10(12):627-630. doi:10.1016/S0196-0644(81)80085-6
• 5. Reis AMM, Cassiani SHDB. Adverse drug events in an intensive care unit of a university hospital. Eur J Clin Pharmacol. 2011;67(6):625-632. doi:10.1007/S00228-010-0987-Y
• 6. Ali I, Bazzar A, Hussein N, Sahhar E. Potential drug-drug interactions in ICU patients: a retrospective study. Drug Metab Pers Ther. 2020;35(3). doi:10.1515/DMPT-2020-0114
• 7. Rahimi B. Prevalance of Potential Drug Interactions in Patients in the Intensive Care Unit of Urmia Taleghani Hospital Web-Based Dental PACS in Urmia View Project Breast Feeding Dose-Response Relationship with Breast Cancer View Project.; 2013. https://www.researchgate.net/publication/259306060
• 8. Radder R, M PB. Drug-drug interaction study in an intensive care unit: An assessment of prevalence, nature, and severity of the medications involved. Natl J Physiol Pharm Pharmacol. 2019;290. doi:10.5455/njppp.2019.9.010230402
• 9. Rodrigues AD. Drug-Drug Interactions, Second Edition. Drug-Drug Interactions, Second Edition. Published online January 1, 2019:1-744. doi:10.1201/9780429131967
• 10. Dagdelen MŞ, Gulen D, Ceylan I, Girgin NK. Evaluation of potential drug-drug interactions in intensive care unit. Eur Rev Med Pharmacol Sci. 2021;25(18):5801-5806. doi:10.26355/EURREV_202109_26798
• 11. Garpestad E, Devlin JW. Polypharmacy and Delirium in Critically Ill Older Adults: Recognition and Prevention. Clin Geriatr Med. 2017;33(2):189-203. doi:10.1016/J.CGER.2017.01.002
• 12. Beckett RD, Stump CD, Dyer MA. Evaluation of drug information resources for drug-ethanol and drug-tobacco interactions. J Med Libr Assoc. 2019;107(1):62. doi:10.5195/JMLA.2019.549
• 13. Grannell L. Drug interaction resources: mind the gaps. Aust Prescr. 2020;43(1):18. doi:10.18773/AUSTPRESCR.2020.005
• 14. Shariff A, Sridhar SB, Basha NFA, Alshemeil SSHBT, Noora Adel Ahmed Aljallaf Alzaabi I. Assessing Consistency of Drug-Drug Interaction-Related Information Across Various Drug Information Resources. Cureus. 2021;13(3). doi:10.7759/CUREUS.13766
• 15. Hecker M, Frahm N, Bachmann P, et al. Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases. Front Pharmacol. 2022;13:946351. doi:10.3389/FPHAR.2022.946351/BIBTEX
• 16. 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. doi:10.4103/2279-042X.192461
• 17. Reis AMM, Cassiani SHDB. Evaluation of three brands of drug interaction software for use in intensive care units. Pharmacy World and Science. Published online December 21, 2010. doi:10.1007/S11096-010-9445-2/TABLES/4
• 18. Westreich D. Berksons bias, selection bias, and missing data. Epidemiology. 2012;23(1):159-164. doi:10.1097/EDE.0B013E31823B6296
• 19. Patel RI, Beckett RD. Evaluation of resources for analyzing drug interactions. J Med Libr Assoc. 2016;104(4):290. doi:10.3163/1536-5050.104.4.007
• 20. Clauson KA, Marsh WA, Polen HH, Seamon MJ, Ortiz BI. Clinical decision support tools: Analysis of online drug information databases. BMC Med Inform Decis Mak. 2007;7(1):1-7. doi:10.1186/1472-6947-7-7/TABLES/5
• 21. Marcath LA, Xi J, Hoylman EK, Kidwell KM, Kraft SL, Hertz DL. Comparison of nine tools for screening drug-drug interactions of oral oncolytics. J Oncol Pract. 2018;14(6):e368-e374. doi:10.1200/JOP.18.00086
• 22. Shakeel F, Fang F, Kidwell KM, Marcath LA, Hertz DL. Comparison of eight screening tools to detect interactions between herbal supplements and oncology agents. https://doi.org/101177/1078155220905009. 2020;26(8):1843-1849. doi:10.1177/1078155220905009
• 23. Chelkeba L, Alemseged F, Bedada W. Assessment of potential drug-drug interactions among outpatients receiving cardiovascular medications at Jimma University specialized hospital, South West Ethiopia. Int J Basic Clin Pharmacol. 2013;2(2):144. doi:10.5455/2319-2003.ijbcp20130306
• 24. Straubhaar B, Krähenbühl S, Schlienger RG. The prevalence of potential drug-drug interactions in patients with heart failure at hospital discharge. Drug Saf. 2006;29(1):79-90. doi:10.2165/00002018-200629010-00006/FIGURES/TAB5
• 25. Reis AMM, Cassiani SH de B, Max A, et al. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. 2011;66(1):9-15. doi:10.1590/S1807-59322011000100003
• 26. Mirosevic Skvrce N, Macolic Sarinic V, Mucalo I, Krnic D, Bozina N, Tomic S. Adverse drug reactions caused by drug-drug interactions reported to Croatian Agency for Medicinal Products and Medical Devices: a retrospective observational study. Croat Med J. 2011;52(5):604. doi:10.3325/CMJ.2011.52.604
• 27. Becker CD, Sabang RL, Nogueira Cordeiro MF, Hassan IF, Goldberg MD, Scurlock CS. Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes. Am J Med. 2020;133(10):e568-e574. doi:10.1016/J.AMJMED.2020.03.012
• 28. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78(12):1471-1478. doi:10.4065/78.12.1471
• 29. Bochicchio G V., Sung J, Joshi M, et al. Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;58(5):921-924. doi:10.1097/01.TA.0000162141.26392.07
• 30. Dai D, Feinstein JA, Morrison W, Zuppa AF, Feudtner C. Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in ICUs of U.S. children’s hospitals. Pediatric Critical Care Medicine. 2016;17(5):e218-e228. doi:10.1097/PCC.0000000000000684
• 31. Kaye AD, Beakley BD, Kaye AM, Kaye AD. Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review. Pain Physician. 2015;18:395-400. Accessed August 29, 2023. www.painphysicianjournal.com
• 32. Hadjibabaie M, Badri S, Ataei S, Moslehi AH, Karimzadeh I, Ghavamzadeh A. Potential drug-drug interactions at a referral hematology-oncology ward in Iran: A cross-sectional study. Cancer Chemother Pharmacol. 2013;71(6):1619-1627. doi:10.1007/s00280-013-2162-5
• 33. DDinter. Accessed September 25, 2023. http://ddinter.scbdd.com/inter-checker/