Frequency, Levels and Predictors of Potential Drug-Drug Interactions in a Pediatrics Ward of a Teaching Hospital in Pakistan

Mohammad Ismail¹, Zafar Iqbal^1*, Muhammad I Khan², Arshad Javaid³, Hassan Arsalan⁴, Farhadullah⁴, Faramoz Khan⁵, Amir Z Khan¹, Fazli Nasir¹ and Jamshaid A Khan¹

¹Department of Pharmacy, University of Peshawar, Peshawar, ²Ayub Medical College, Abbottabad, Khyber Pakhtunkhwa, ³Post Graduate Medical Institute, Lady Reading Hospital (LRH), Peshawar, ⁴Department of Pharmacy, Sarhad University of Science & Information Technology, Peshawar ⁵Medical-B Unit, Khyber Teaching Hospital, Peshawar, Pakistan. 

*For correspondence: Email: zafar_iqbal@upesh.edu.pk  Tel: +92-91-9216750; Fax: +92-91-9218131  

Received:  13 August 2012                                                                                  Revised accepted: 16 April 2013

Tropical Journal of Pharmaceutical Research, June 2013; 12(3): 401-406

Purpose: To identify the frequency, levels and predictors of potential drug-drug interactions (pDDIs) in a pediatrics ward of a teaching hospital in Pakistan.

Methods: Medication profiles of 400 pediatric patients were evaluated for pDDIs using Micromedex Drug-Reax® software. Logistic regression was used to identify association of pDDIs with hospital-stay, patient’s gender, and number of medications.

Results: In total, 86 interacting drug-combinations resulting in 260 pDDIs were identified. Overall, 25.8 % patients were exposed to at least one pDDI regardless of severity-type, 10.7 % to at least one major-pDDI, 15.2 % to at least one moderate-pDDI, and 12.5 % to at least one minor-pDDI. Of 260 pDDIs, most were of moderate severity (41.5 %) followed by minor (35.4 %) and major severity (21.9 %); good (76.9 %) or fair (16.5 %) type of scientific evidence; and delayed onset (46.5 %). Some widespread major or moderate interactions included rifampin + pyrazinamide (14 cases), phenobarbital + diazepam (14), dexamethasone + rifampin (8), amikacin + furosemide (7), furosemide + captopril (7), dexamethasone + phenobarbital (6), phenobarbital + divalproex sodium (6), isoniazid + rifampin (5) amikacin + ibuprofen (5), digoxin + furosemide (4), and acetaminophen + phenytoin sodium (4). There was significant association of the occurrence of pDDIs with five or more prescribed medications (p < 0.001). 

Conclusion: PDDIs are less prevalent in the pediatrics ward of the hospital studied. Most of the interactions were of moderate severity. Patients with increased number of prescribed medications were more exposed to these interactions.