DRUG–DRUG INTERACTIONS IN THE PHARMACOTHERAPY OF DIABETIC KETOACIDOSIS: A RETROSPECTIVE ANALYSIS FROM A TERTIARY CARE HOSPITAL IN PESHAWAR, PAKISTAN

Abstract

Background: Patients admitted with diabetic ketoacidosis (DKA) typically require complex, multi-drug regimens spanning insulin therapy, antibiotics, anticoagulants, and other supportive medications, creating meaningful potential for clinically significant drug–drug interactions (DDIs) that can compromise safety and complicate an already high-acuity presentation.

Objective: To identify and characterize the frequency, severity, and mechanisms of drug–drug interactions in the pharmacotherapy of hospitalized DKA patients at a tertiary care hospital in Peshawar, Pakistan.

Methods: A retrospective medical chart review of 20 DKA patients admitted to the Endocrinology Ward, Emergency Room, and Acute Medical Unit of Lady Reading Hospital, Peshawar. Complete prescribed medication lists were extracted for each patient and systematically screened for drug–drug interactions using the Drugs.com and Medscape interaction-checking databases, with severity classified as minor, moderate, or major.

Results: Across the 20-patient cohort, a total of 6 clinically relevant drug–drug interactions were identified: 2 (33.3%) classified as major and 4 (66.7%) as moderate. The major interactions were clonazepam–olanzapine (pharmacodynamic; increased risk/severity of adverse effects) and fluconazole–clopidogrel (pharmacokinetic; decreased clopidogrel metabolism/activation). The moderate interactions were moxifloxacin–insulin aspart (pharmacokinetic; increased insulin efficacy/hypoglycemia risk), aspirin–enoxaparin (pharmacodynamic; increased anticoagulant activity), doxylamine–tramadol (pharmacodynamic; additive CNS depression), and insulin glargine–dexamethasone (pharmacokinetic; increased hyperglycemia risk). By mechanism, 4 of 6 interactions (66.7%) were pharmacodynamic and 2 (33.3%) pharmacokinetic. No severe or contraindicated interactions were identified.

Conclusion: Clinically relevant drug–drug interactions, including two major-severity interactions, were identified in the pharmacotherapy of hospitalized DKA patients, most commonly involving psychotropic, anticoagulant, and glucose-modulating agent combinations. These findings support the routine use of systematic interaction-checking tools and closer interdisciplinary communication between physicians, pharmacists, and nursing staff to detect and manage such interactions proactively in this high-acuity patient population.