Hyperpolypharmacy in intensive care: Medicines interactions between centrally acting drugs

The prescription of multiple drugs increases the likelihood of drug interactions, making the use of drugs in intensive care unit patients challenging.

To analyze the occurrence of hyperpolypharmacy and potential drug interactions between centrally-acting drugs and drugs from other pharmacological classes on the first and last day of admission to an intensive care unit.

Descriptive study with patients in a hospital in the state of São Paulo, Brazil. The study included patients of both sexes over the age of 18. The patients included had been in the ICU for three days or more, had multiple diagnoses and were taking centrally-acting drugs. Data was collected using the Philips Tasy health management software, that provides information on age, gender, marital status, outcome, polypharmacy, hyperpolypharmacy and results of laboratory blood tests. Data was also collected on prescribed medication. Micromedex® software was used to analyze the occurrence of potential drug interactions and a logistic regression model was used to analyze the data.

A higher risk of death was identified in patients aged 40-59 years (OR = 7.36; P = .010; CI 1.39-38.80) and in those taking cardiovascular medications that interact with other medications (OR = 4.41; P = .007; CI 1.48-13.08). Severe drug interactions were associated with regular documentation (OR = 3.54; P = .014; CI 1.32-9.46) and an unspecified time of onset (OR = 27.76; P < .001; CI 7.53-102.2). Moderate drug interactions were associated with the time of onset: a nonspecific onset increased the incidence by 13.13 times (P < .001; CI 3.24-53.17), while a delayed onset increased this probability by 24.85 times (P < .001; CI 5.32-115.9).

The results reveal the need to invest in educational strategies to reduce drug interactions in the intensive care unit, with a view to identifying potential drug interactions at an early stage.