Drug Interactions

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A drug interaction occurs when one drug alters the effectiveness or toxicity of another. Clinically significant drug interactions, which pose potential harm to the patient, may result from changes in pharmaceutical, pharmacokinetic, or pharmacodynamic properties. Required in vitro studies conducted by drug manufacturers help predict the potential occurrence of a drug interaction, but they do not confirm the clinical relevance for patients, and they are not sufficiently sensitive to identify all potentially serious interactions, especially in the pediatric population.

Patient factors that increase the risk for drug interactions include being critically ill; receiving polypharmacy; having impaired hepatic or renal function, hypoxemia, or metabolic disturbances; and being elderly. Given the paucity of data on drug interactions in pediatric patients, children also should be considered at special risk. Drug characteristics that contribute to interactions include high potency, wide usage, action on vital organ functions, narrow therapeutic index, saturable hepatic metabolism, and extensive protein binding (>90%).

Drug interactions can be used strategically to benefit …