Potential Drug-Drug Interactions in Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital in Nepal: A Descriptive Cross-Sectional Study

Abstract

Background
Potential drug-drug interactions (pDDIs) are a major concern in Intensive Care Units (ICUs) due to polypharmacy, severe illness, and complex treatment regimens. These interactions can lead to adverse clinical outcomes. This study aimed to determine the prevalence, severity, and predictors of pDDIs among ICU patients in a tertiary care teaching hospital in Nepal.
Methods
A descriptive cross-sectional study was conducted among 150 ICU patients at Universal College of Medical Sciences from Nov 2023 to April 2024. Patient demographics and drug profiles were collected from Cardex records. The pDDIs were identified using the Medscape drug interaction checker and classified by severity. Binary logistic regression was performed to identify predictors, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).
Results
Among 150 patients, 118 (78.67%) had at least one pDDIs. A total of 433 interactions were identified from 1074 prescribed medications, with an average of 7.16 drugs per patient. Most interactions were classified as ‘monitor closely’ (53.35%), followed by minor (31.4%), serious (13.6%), and contraindicated (1.6%). Polypharmacy was observed in 71.3% of patients. It was the only significant predictor of pDDI (AOR=9.33, 95% CI: 3.78-23.2, p<0.001).
Conclusions
The pDDIs are highly prevalent among ICU patients. Polypharmacy is the main independent predictor, while age and comorbidities are not significantly associated. The finding highlights the importance of careful medication review and further studies to assess their clinical relevance.