Abstract
BackgroundChild and adolescent mental health problems are common in the community, but the scientific basis for the treatment of many of these conditions is still in its infancy. Prescriptions of psychotropic medications have become an important intervention for many children and adolescents with mental disorders, and the rise of these prescriptions is debated intensively both among experts and the public. The overall prescription rates of psychotropics in general and the major medication subgroups prescribed to children and adolescents vary substantially between countries. Therefore, they are also at escalated risk of QT interval protracting drug-drug interactions. ObjectivesTherefore, we have analyzed the prescribing pattern of QT-prolonging drugs and drug-drug interactions in children and adolescent psychiatric patients. MethodsThis was a cross-sectional prospective study conducted in Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand from October 1, 2016, to December 31, 2018, employing the pertinent prescriptions. ResultsPrescriptions for 1682 patients (aged 0 to 18 years) during the aforementioned study period were investigated. 1146 patients were males and 536 were females in our study. 1317 (78.3%) patients were using drugs with a capacity to induce TdP. 2894 QT-prolonging drug-drug interaction pairs have been identified. As per CredibleMeds (AzCERT) Classification, 2881 (53.2%), 1982 (36.6%), and 472 (8.7%) interacting drugs were identified with known, possible and conditional risk of TdP, respectively. The common interacting medications belong to psychostimulant (968), antimicrobial (548), proton pump inhibitor (517), antinausea (467), antitubercular (462), antidepressant (436), and antipsychotic (421) therapeutic categories. ConclusionsMany children and adolescent psychiatric patients in the OPD were prescribed drugs and drug combinations. Many of these have an elevated risk of prolonging QT interval and precipitating TdP. Therefore, it is imperative to adopt precautionary measures, be watchful, and prevent QT prolongation in clinical settings. Various online evidence based drug-drug interaction resources can help physicians to select appropriate medications judiciously for children and adolescent psychiatric outpatients.
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