High-alert medications in the pediatric care: framework for drug-drug interactions

Abstract

Background: Drug interactions with high-alert medications are of great importance, because the high-alert medications have reduced safety and high susceptibility to cause damage, such as severe adverse reactions. Pediatric patients have higher risk of injuries, requiring more attention to their treatment. This study aimed to propose a reference list with the description of interactions potentially dangerous for pediatric patients. Methods: The drugs classified as high-alert medications in the literature, present in the National List of Essential Medicines for Children and displayed according to the WHO model list were analyzed. Then, drug interactions defined as serious were searched in the MICROMEDEX database. Results: Twenty-two high-alert medications indicated for children - amoxicillin, ampicillin, calcium, cephalexin, cefotaxime, ceftazidime, digoxin, dopamine, epinephrine, phenobarbital, furosemide, gentamicin, heparin, imipenem with cilastatin, insulin, lidocaine, midazolam, morphine, penicillin, propofol, propranolol and sulfametaxazol with trimethoprim - had 102 serious drug interactions investigated and described. Many of these drugs had a large number of interactions, justifying the need for monitoring their use. Conclusion: It is estimated that the proposed instrument can contribute to the safety of pediatric patients when using high-alert medications.