Keywords
Cytochrome P450
Intensive Care Unit
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Abstract
Objective: To provide information on the main physiological alterations that may influence the pharmacological properties in critically ill patients and clinically relevant drug interactions mediated by cytochrome P450 enzymes. Bibliographic review: Patients hospitalized in the Intensive Care Unit (ICU) often present physiological alterations that cause changes in the pharmacological profile of several medications. The presence of hepatic and renal dysfunctions, hypoxia and peripheral ischemia, circulatory disorders, the elevation of inflammatory markers, hypoalbuminemia, and obesity alter the parameters of absorption, distribution, metabolization, and excretion of drugs. These modifications together with the concomitant use of several drugs represent a great challenge for the pharmacotherapeutic approach of these patients. Among the wide pharmacological classes, emphasizing triazole antifungals due to their impact and use in ICUs. Final considerations: Knowledge of pharmacokinetic changes in critically ill patients and the modulation of cytochrome P 450 enzymes is valuable to prevent and managing possible drug interactions, especially in ICUs. The joint action of intensivists and clinical pharmacists can considerably optimize pharmacotherapeutic treatment.
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