Drug Interactions in Neurocritical Care

• Published in: Neurocritical care Vol. 27; no. 2; pp. 287 - 296
• Main Authors: Spoelhof, Brian, Farrokh, Salia, Rivera-Lara, Lucia
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2017; Springer Nature B.V
• Subjects: Acids; Anesthesia; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - pharmacology; Antibiotics; Anticoagulants; Anticonvulsants - adverse effects; Anticonvulsants - pharmacology; Calcium Channel Blockers - adverse effects; Calcium Channel Blockers - pharmacology; Convulsions & seizures; Critical Care - standards; Critical Care Medicine; Cytochrome; Disease prevention; Drug dosages; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Enzymes; Fentanyl; Glycoproteins; Hematologic Agents - adverse effects; Hematologic Agents - pharmacology; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - pharmacology; Intensive; Internal Medicine; Liver diseases; Medicine; Medicine & Public Health; Metabolism; Metabolites; Nervous System Diseases - drug therapy; Nervous System Diseases - therapy; Neurology; Oxidation; Pharmacodynamics; Pharmacokinetics; Proteins; Review Article; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - pharmacology; Drug metabolism; Antiepileptics; Adverse drug reactions; Neurocritical care; Drug interactions; Calcium channel blockers
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-016-0369-0

Drug–drug interactions (DDIs) are common and avoidable complications that are associated with poor patient outcomes. Neurocritical care patients may be at particular risk for DDIs due to alterations in pharmacokinetic profiles and exposure to medications with a high DDI risk. This review describes the principles of DDI pharmacology, common and severe DDIs in Neurocritical care, and recommendations to minimize adverse outcomes. A review of published literature was performed using PubMed by searching for ‘Drug Interaction’ and several high DDI risk and common neurocritical care medications. Key medication classes included anticoagulants, antimicrobials, antiepileptics, antihypertensives, sedatives, and selective serotonin reuptake inhibitors. Additional literature was also reviewed to determine the risk in neurocritical care and potential therapeutic alternatives. Clinicians should be aware of interactions in this setting, the long-term complications, and therapeutic alternatives.