# Drug–Drug Interactions in Patients with Acute Respiratory Distress Syndrome

## TL;DR

This study found that drug interactions are common in ARDS patients, especially those treated with ECMO, but not more so in those with COVID-19-related ARDS.

## Contribution

The study is the first to analyze drug–drug interactions in ARDS patients and link ECMO treatment with increased severe interactions.

## Key findings

- 2694 drug–drug interactions were identified in 189 ARDS patients.
- ECMO-treated patients had significantly higher rates of severe drug interactions.
- No difference in interactions was found between COVID-19 and non-COVID-19 ARDS patients.

## Abstract

Acute respiratory distress syndrome (ARDS) is a potential life-threatening, heterogenous, inflammatory lung disease. There are no data available on potential drug–drug interactions (pDDIs) in critically ill patients with ARDS. This study analyzed pDDIs in this specific cohort and aimed to investigate possible associations of coronavirus disease 2019 (COVID-19) as an underlying cause of ARDS and treatment with extracorporeal membrane oxygenation (ECMO) with the occurrence of pDDIs. This retrospective study included patients ≥18 years of age diagnosed with ARDS between January 2010 and September 2021. The Janusmed database was used for the identification of pDDIs. A total of 2694 pDDIs were identified in 189 patients with a median treatment duration of 22 days. These included 323 (12%) clinically relevant drug combinations that are best avoided, corresponding to a median rate of 0.05 per day. There was no difference in the number of pDDIs between COVID-19- and non-COVID-19-associated ARDS. In patients treated with ECMO, the rate of the most severely graded pDDIs per day was significantly higher compared with those who did not require ECMO. PDDIs occur frequently in patients with ARDS. On average, each patient may encounter at least one clinically relevant drug combination that should be avoided during their intensive care unit stay.