INTRODUCTION:

Drug–drug interactions (DDIs) occur when the effects of one medication are altered by the presence of another.¹ These changes may result from pharmacokinetic or pharmacodynamic mechanisms and can lead to decreased drug effectiveness, reduced therapeutic success, or heightened toxicity.² In some instances, such interactions can cause severe adverse drug events, potentially requiring hospitalization. Studies estimate that DDIs contribute to approximately 3% of hospital admissions.³ Furthermore, it has been observed that 37–60% of hospitalized individuals may already be receiving drug combinations with the potential to interact upon admission.⁴ The likelihood of such interactions increases during hospital stays due to the addition of new medications to ongoing treatment plans.

The growing use of multiple drugs, especially in patients with complex or multiple health conditions (a practice known as polypharmacy), further increases the risk of DDIs. These interactions represent a significant challenge in clinical practice, as they can lead to harmful outcomes, including treatment complications and increased mortality rates.⁵ For this reason, it is essential that healthcare providers are equipped to detect and manage DDIs to enhance patient safety.⁶Monitoring the occurrence of clinically meaningful DDIs and identifying vulnerable patients during medical evaluations can help reduce medication-related issues and improve the quality of care.⁷ The potential advantages of using multiple drugs should always be balanced against the possible risks, taking into account alternative treatment options. When no safer alternatives are available, and the expected benefit is greater than the potential harm, continuing treatment—with careful supervision—may still be appropriate.⁸

In general, a drug interaction refers to any modification in a drug's action or side effects that occurs when it is taken alongside another substance, such as food, drink, supplements, or other medications.⁹The chance of experiencing such interactions grows with the number of substances being consumed.¹⁰ In these cases, the drug whose effect is altered is termed the “object drug”, while the substance that triggers the interaction is known as the “precipitant”.¹⁰

Mechanisms of Drug Interactions:

1. Behavioral drug-drug interaction: altered compliance:

When one drug alters the patient’s behavior to modify compliance with another drug.

Example: depressed patient taking an antidepressant drug may become more compliant to the drug as symptoms improve.

2. Pharmaceutic drug-drug interactions: outside the body:

It is a physicochemical interaction that occurs when drugs are mixed with i.v. infusions causing precipitation or inactivation of active principles before it is administered.

Example: Precipitation of sodium thiopentone within an intravenous dose.

3. Pharmacokinetic drug-drug interactions: altered concentration or effect:

These interactions occur when one drug changes the systemic concentration of another drug, altering how-much or how-long, it is present at the site of action. Pharmacodynamic drug-drug interactions occur when interacting drugs have either additive effects (overall effect increased) or opposing effects (overall effect decreased or even cancelled out).¹¹

Methodology:

1. Selection of Pediatric Participants: The observational study was conducted from July 2024 to September 2024 at Sadguru Clinic, Zarekati Taluka, Sangamner District, Ahmednagar. The study was approved by Dr. Sumit Wakchaure (BHMS). Pediatric patients who were prescribed more than two medications were selected for inclusion in the study.

2. Data Collection from Patient Records: Patient information was gathered from various sources, including patient case sheets, medical records, and a Drug–Drug Interaction (DDI) documentation form specifically designed for this study.

3. Prescription Review and Analysis: The prescribed medications were thoroughly examined, focusing on drug combinations, their mechanisms of action, dosages, and the potential effects of these combinations.

4. Analysis of Drug - Drug interaction using Software: Drug–Drug Interactions (DDIs) were assessed using the drug interaction checker available on the www.drugs.com website, which is powered by four reputable medical information providers: Wolters Kluwer Health, the American Society of Health-System Pharmacists, Cerner Multum, and Thomson Reuters Micromedex.

RESULT AND DISCUSSION:

The patient information is as Follows:

1. Selection of Pediatric Patient: The observational study was conducted at Sadguru Clinic, located in Zarekati Taluka, Sangamner District, Ahmednagar, with approval from Dr. Sumit Wakchaure (BHMS). Pediatric patients who were prescribed more than two medications were selected for inclusion in the study. The pediatric patient, Mauli Wakchauri, was chosen for the Drug–Drug Interaction study.

2. Collection of Patient Information: Patient information was gathered using observation sheets, medical records, and a specially designed Drug–Drug Interaction (DDI) documentation form for the study.

a. Personal information:

Table 1: Personal Information

Name	Mauli Wakchaure
Age	8 years
Adress	A/p Zarekati Tal-sangamner Dist-Ahmednagar
Birth Date	07/03/2016
Weight	22 kg

b. Patient observation Sheet

Table 2: Patient observation Sheet

Parameter	Observation
Weight	22 kg
Blood pressure	110/85 mm hg
Body Temperature	100
Breathing	Congestion so difficulty in breaching
Other	The patient has Cold and Fever

1. Study of Prescription:

Figure 1: Prescription

The drugs prescribed to patient studied; the following drugs prescribed to patients.

Table 3: Drug information

Sr.no	Brand Name	Drug Content
1	Advent 228.5	Amoxyllin 200mg, Calvulanic Acid 28.5
2	Maxtra	Chlorpheniramine Maleate (2mg/5ml) ,Phenylephrine (5mg/5ml)
3	Fevfast	Mefenamic Acid (100mg) + Paracetamol (250mg)
4	Mucolite	Ambroxol (30mg/5ml)

2. Analysis of Drug - Drug interaction using Software:

Drug –Drug Interaction checked using drug interaction checker at www.drugs.com.

The result of study of prescribed drug drug interaction is as follows.

Table 4: Analysis of Drug - Drug interaction using Software

Drug Drug Interaction		Severity	Description
Amoxicillin	Chlorpheniramine	Minor	Amoxicillin and Chlorpheniramine may have minimal interaction. Chlorpheniramine may increase drowsiness when combined with other antibiotics, but the effect is usually mild.
Amoxicillin	Phenylephrine	Minor	No significant interaction; however, Phenylephrine may increase blood pressure and Amoxicillin may affect kidney function when combined with other medications.
Amoxicillin	Mefenamic Acid	Moderate	Amoxicillin can increase the absorption of Mefenamic Acid and other NSAIDs. Combining them might slightly raise the risk of gastrointestinal side effects or renal toxicity.
Chlorpheniramine	Phenylephrine	Moderate	Combining Chlorpheniramine (sedative antihistamine) with Phenylephrine (sympathomimetic) may cause an increased risk of drowsiness and dizziness due to CNS depression.
Chlorpheniramine	Mefenamic Acid	Moderate	Chlorpheniramine combined with Mefenamic Acid may increase the sedative effects, leading to heightened drowsiness or dizziness.
Chlorpheniramine	Paracetamol (Acetaminophen)	Minor	Chlorpheniramine and Paracetamol may interact mildly, though the primary concern is increased sedation or CNS depression when taken together.
Phenylephrine	Paracetamol (Acetaminophen)	Minor	No significant interaction, but Phenylephrine may affect the cardiovascular system, which can be a concern when combined with other medications.
Mefenamic Acid	Paracetamol (Acetaminophen)	Moderate	Mefenamic Acid and Paracetamol should be used cautiously together, as both drugs may cause liver or kidney damage, especially in high doses.
Paracetamol (Acetaminophen)	Ambroxol	Minor	No significant drug interaction, but it’s important to monitor liver function when combining with other drugs affecting liver metabolism.

CONCLUSION:

Drug–drug interactions (DDIs) are a major concern in pediatric healthcare, as they can affect the safety and effectiveness of medications. In this study, we looked at the prescribed drugs for a pediatric patient and used a drug interaction checker to find potential DDIs. The results showed that while many interactions were minor, some combinations, like Chlorpheniramine with Mefenamic Acid or Phenylephrine, could cause problems like increased drowsiness, dizziness, or higher blood pressure. The combination of Mefenamic Acid and Paracetamol also raised concerns about liver or kidney damage.This highlights the importance of being careful when prescribing multiple medications to children, as they are more vulnerable to side effects. Using tools like drug interaction checkers can help healthcare providers identify potential problems early. It is essential for doctors and pharmacists to work together and monitor patients closely when they are on multiple medications.

Overall, while drug interactions are common, they can be managed with careful planning, monitoring, and the use of technology. This study emphasizes the need for healthcare professionals to stay alert to potential DDIs to ensure safer and more effective treatments for pediatric patients.

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Received on 18.04.2025 Revised on 09.06.2025

Accepted on 26.07.2025 Published on 08.08.2025

Available online from August 14, 2025

Research J. Science and Tech. 2025; 17(3):207-210.

DOI: 10.52711/2349-2988.2025.00028

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