Drug-drug interactions among pediatric intensive care unit: Risk factors and clinical Outcomes

Document Type : Original Article

Authors

1 Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Pediatrics, Division of Intensive Care Unit, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/tips.2026.110716.1351

Abstract

Objectives: To determine the frequency, risk factors, and clinical outcomes of drug–drug interactions (DDIs) in a pediatric intensive care unit (PICU).
Methods: We conducted a cross-sectional study (June 2022–February 2023) of children admitted ≥48 hours to medical or surgical PICUs with ≥2 prescribed medications. DDIs were identified and classified using Lexi-Interact®. Demographic/clinical data and medications were collected prospectively; severity and reliability ratings were recorded. Associations with DDIs were analysed using univariable and multivariable logistic regression.
Results: Among 345 included patients, 1858 DDIs were detected; category C: 1248 (≈67%), category D: 529 (≈29%), category X: 81 (≈4%). DDIs were more frequent in the medical PICU than the surgical PICU. The most frequent contraindicated (X) interaction involved linezolid–methadone. In multivariable analysis, the number of prescribed drugs and use of sedatives were independent predictors of DDIs; ward type (medical vs surgical) was also associated with higher DDI burden.
Conclusions: DDIs were common in this PICU cohort. Polypharmacy—particularly involving sedatives—was the principal modifiable risk factor. Heightened monitoring and stewardship targeting high-risk combinations may mitigate DDI-related harm

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