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Drug Incompatibility in Pediatrics
In infusion therapy, drug incompatibility is a well-known challenge. In pediatrics and neonatology, this is no exception. This makes it even more important to know which risk factors you should be aware of, and which measures you can take to protect your young patients from harmful drug interactions.
Drug incompatibility is the undesirable reaction between a drug and a solution, container or another drug. There are either physical or chemical types of incompatibilities associated with intravenous administration.1, 2
Pediatric and neonatal patients in hospitals are often affected by polypharmacy. The concurrent use of multiple medications poses a significant risk of adverse drug events (ADEs) also connected to drug–drug incompatibility.7
Major drug–drug interactions can be life-threatening. At one children's hospital, older patients or patients with longer hospital stays or with complex chronic conditions (CCC) were more likely to be exposed to that risk. In the 10-year-old to 20-year-old age group, potential drug–drug interactions (PDDI) occurred in more than half of the patients.7
“Exposure to major potential drug-drug interactions occurs in 41% of pediatric hospitations in childrens hospitals.”
The number of drugs prescribed could be identified as a risk factor for potential intravenous drug incompatibility. In addition, pH level is the major factor for drug incompatibility. Drugs with an extreme pH, such as phenobarbital and phenytoin, are more likely to contribute to the risk.8
In day-to-day operations at the pediatric or neonatal ICU, separate drug administration is often not possible due to the large number of intravenous drugs used and limited venous access.6
Furthermore, high off-label use in pediatrics and neonatology compared to adult patients is an associated risk, resulting in only a limited number of drugs being approved for children.8
Drug incompatibility can have serious health consequences for patients in pediatrics and neonatology. In addition, the financial aspect for pediatric and neonatal wards and hospitals is not to be underestimated due to prolonged hospitalizations. To prevent the risk of drug interactions, we want to raise awareness of the possible adverse reactions beforehand.
Potential drug interactions may lead to:
Depending on the various treatment processes and individual risk factors for potential incompatibilities, there are a number of preventive solutions.
In general, the following strategies should be considered to increase safety with regard to drug incompatibilities, especially in intravenous therapy.
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1. Fahimi F, Sefidani Forough A, Taghikhani S, Saliminejad L. The rate of Physicochemical Incompatibilities, Administration Errors. Factors correlating with Nurses’ errors. Iran J Pharm Res 2015; 14(suppl); 87-93.
2. RCN Royal College of Nursing. Standards for Infusion Therapy. 2010.
3. Emami S, Hamishehkar H, Mahmoodpoor A, Mashayekhi S, Asgharian P. Errors of oral medication administration in a patient with enteral feeding tube. J Res Pharm Pract 2012; 1: 37-40.
4. Vijayakumar A, Sharon EV, Teena J, Nobil S, Nazeer I. A clinical study on drug-related problems associated with intravenous drug administration. J Basic Clin Pharm 2014; 5(2): 49-53.
5. Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011; 20(12): 1027-34.
6. Neininger MP, Buchholz P, Kiess W, SIekmeyer M, Bertsche A, Bertsche T. Incompatibilities on paediatric intensive care – pitfalls in durg information. Pharmazie 2018;73(10): 605-8.
7. Feinstein J, Dai D, Zhong W, Freedman J, Feudtner C. Potential drug-drug interactions in infant, child, and adolescent patients in children’s hospitals. Pediatrics 2015;135(1): e99-108.
8. Leal KD, Leopoldino RW, Martins RR, Veríssimo LM. Potential intravenous drug incompatibilities in a pediatric unit. Einstein (Sao Paulo) 2016;14(2):185-9.
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