Drug–drug interactions in hospitalized children with liver diseases: incidence, severity, and risk factors

Abstract Objective To assess the frequency and severity of potential drug–drug interactions (pDDIs) among hospitalized children with liver diseases. Methods This observational longitudinal inpatient surveillance study included children with liver diseases who were admitted over four months. pDDIs were assessed using two DDI screening programs: Lexicomp and Medscape Interaction Checker. Results The study included 50 patients. Most patients had cholestatic disorders of infancy (76%). Twenty patients (40%) experienced at least one pDDI. The total number of pDDIs identified was 52. Mild pDDIs accounted for 34.5%, moderate pDDIs for 54%, and severe pDDIs for 11.5%. The most commonly prescribed drugs were fat-soluble vitamins, whereas the drugs most frequently involved in pDDIs were fluconazole and corticosteroids. In most cases, the recommended action was monitoring only. Interactions involving fluconazole and other drugs require monitoring for QT prolongation. The number of severe pDDIs per patient was significantly higher in older patients ( P = 0.007) and in underweight patients ( P = 0.044). Patients who had undergone the Kasai procedure had a longer hospital stay and a higher frequency of DDIs. Conclusion pDDIs are common among hospitalized children with liver diseases, with most being of moderate severity. Fluconazole was the drug most commonly associated with severe pDDIs and requires monitoring for QT prolongation. The frequency of severe pDDIs was associated with older age and underweight status.