Table 4.

The 10 potential major drug interactions most commonly detected at admission

Major drug interactions	Documentation status	Potential risk	n (%)
Aspirin-enoxaparin	Good	Increased risk of bleeding	21 (7.3)
Clopidogrel-omeprazole	Excellent	Increased risk for thrombosis	11 (3.8)
Clopidogrel-enoxaparin	Fair	Increased risk of bleeding	10 (3.5)
Fentanyl-morphine	Fair	Increased risk of CNS depression	10 (3.5)
Aspirin-clopidogrel	Fair	Increased risk of bleeding	8 (2.8)
Fentanyl-lorazepam	Fair	Increased risk of CNS depression	6 (2.1)
Omeprazole-citalopram	Fair	Increased risk of QT interval prolongation	6 (2.1)
Citalopram-enoxaparin	Good	Increased risk of bleeding	5 (1.7)
Lorazepam-zolpidem	Fair	Increased risk of CNS depression	5 (1.7)
Quetiapine-trazodone	Fair	Increased risk of QT interval prolongation	5 (1.7)
Total			87/289 (30.1)

CNS, central nervous system.