More than half of the patients receiving high-alert medications were affected by a total of 3203 symptoms observed after drug–drug interactions involving high-alert medications. More than one in four observed symptoms were associated with a drug–drug interaction at a significant odds ratio.

Specific drug pairs were identified that may increase the risk of interaction-associated symptoms, mainly categorized as hemodynamic alterations and fluid and electrolyte balance disturbances. Those drug pairs involved eight drugs frequently administered in a PICU.

Physicians should avoid the administration of these specific drug pairs, or if their administration is unavoidable, monitor patients closely for corresponding symptoms.