In a prospective observational study of 93 critically ill patients at a tertiary care ICU, researchers identified 123 drug-drug interactions (DDIs), with 15% classified as major and 6% as contraindicated using Lexicomp risk rating.

That means more than one in seven patients experienced at least one high-risk interaction.

Common culprits included clopidogrel and heparin as the most frequent “victim” drugs, while azithromycin, bisoprolol, and heparin often acted as precipitants.

Major interactions frequently involved azithromycin + heparin combinations and led to clinically observable harm in 28% of cases, manifesting as bleeding, hypotension, or drug toxicity.

Pharmacodynamic interactions slightly outnumbered pharmacokinetic ones.

The study found DDIs were significantly more common in patients over 60 years old and in females, driven largely by polypharmacy.

The authors emphasize that routine medication reconciliation, real-time DDI screening, and vigilant monitoring are essential to reduce preventable adverse events and improve outcomes in the critical care setting.

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