title: Drug Interactions in Neurocritical Care.
abstract: 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.
authors.affiliation: Department of Pharmacy, Lahey Hospital and Medical Center, Burlington, MA, USA. Brian.Spoelhof@lahey.edu.
authors.forename: Brian
authors.identifier: http://orcid.org/0000-0002-3339-9498
authors.initials: B
authors.lastname: Spoelhof
authors.affiliation: Neurocritical Care, Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Salia
authors.initials: S
authors.lastname: Farrokh
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Lucia
authors.initials: L
authors.lastname: Rivera-Lara
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology*; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology*; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000494:pharmacology*; D003422:Critical Care / Q000592:standards*; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D006401:Hematologic Agents / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology*; D009422:Nervous System Diseases / Q000188:drug therapy / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D002121:Calcium Channel Blockers; D006401:Hematologic Agents; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Adverse drug reactions; Antiepileptics; Calcium channel blockers; Drug interactions; Drug metabolism; Neurocritical care