The objective is the development and pilot testing of a evaluation system designed to facilitate the objective and systematic comparison of interaction databases, Especially in the psychiatric context.The study examined medication plans of 104 psychiatric patients. The medication was checked for interactions in twelve databases. A newly developed evaluation system with 11 criteria and a scoring system was used for evaluation.The number of interactions detected differs significantly between the databases. No database achieved the maximum number of points. Paid databases scored better on average (6.4±2,5 points) than free ones (1.5±2,4 points, p=0,009). The best results were achieved by ifap and PGXperts.Psychotropic substances have a high potential for interactions. Using multiple databases is recommended, combined with clinical experience and interdisciplinary collaboration.

The use of multiple QTc-prolonging psychotropic drugs or agents affecting their metabolism can lead to significant drug-drug interactions (DDIs). This study aims to compare the severity ratings of potential DDIs (pDDIs) specified in two interaction databases and identify clinically relevant interactions associated with QTc prolongation in palliative care patients. This prospective study was conducted in a palliative care unit of a state hospital between October 2023 and May 2024. Potential DDIs and their severities were assessed according to Micromedex® and Lexicomp® databases. Electrocardiograms (ECGs) were performed the patients flagged as having the risk of QTc prolongation. The Drug Interaction Probability Scale (DIPS) was applied to evaluate the clinical relevance of the detected interactions. A clinical pharmacist provided recommendations based on DIPS assessments. A total of 209 pDDIs involving 77 different drug pairs were identified among 120 patients. Interrater reliability between the two databases was poor for major pDDIs (kappa = –0.034) and overall (kappa = –0.052). A pDDI involving a psychotropic drug was detected in 61.7% of patients. QTc prolongation was observed in 66.7% of patients who underwent ECG (n=58). According to DIPS, 122 clinically relevant DDIs (63 unique pairs) were identified. Physicians accepted 10.5% of the clinical pharmacist’s recommendations, leading to modifications in psychotropic drug regimens. Follow-up ECGs revealed no QTc prolongation after the interventions. The findings highlight the frequent exposure of palliative care patients to psychotropic drug interactions that may prolong QTc. Although drug interaction databases provide guidance, discrepancies in severity ratings and clinical relevance necessitate individualized patient evaluation by a multidisciplinary team, including clinical pharmacists, to ensure medication safety.

The Anatolian Journal of Family Medicine is an international periodical on family medicine and primary health care, published three times a year on independent, unbiased, double-blinded and peer-review principles.

Mental health is an important segment in preserving overall health and represents a significant public health issue. In modern times, mental health disorders have risen, often requiring complex pharmacotherapy and chronic monitoring. The aim of this research was to determine the prevalence and clinical significance of potential psychotropic drug interactions in outpatient settings and compare the differences in potential drug–drug interaction (pDDIs) exposure with age. The psychotropic drugs included antipsychotics—N05A, anxiolytics—N05B, hypnotics and sedatives—N05C, and antidepressants—N06A. This retrospective study analyzed prescribed pharmacotherapy in 492 outpatients who were treated with at least one psychotropic drug. We determined 1.64 prescribed psychotropic drugs per patient and 2.2 pDDIs that involved psychotropic drugs. In total, 2285 pDDIs were recorded, of which almost half (47.6%) were pDDIs with psychotropic drugs. More prescribed psychotropic drugs were found in patients younger than 65 years, and equal exposure to pDDIs of psychotropic drugs (p = 0.5077) was found in both age groups. The most commonly identified psychotropics involved in pDDIs were benzodiazepines, promazine, and zolpidem. The results indicate that psychotropic drug interactions represent important drug-related problems for primary health care. The widespread use of psychotropic drugs and the determined clinical significance of their interactions require pharmacist interventions which can reduce the prevalence of pDDIs and increase patient safety.

BACKGROUND: The mechanisms of drug interactions of psychotropic drugs are associated with the processes of drug biotransformation by enzymes of microsomal oxidation of cytochrome P-450 in the liver. Various drugs can increase or decrease the activity of enzymes of the cytochrome P450-dependent system. AIM: To evaluate the effect of pharmacotherapy with psychotropic drugs: alprazolam, bromazepam, lithium carbonate on the metabolic rate of the model substrate antipyrine in saliva in patients with neuropsychiatric disorders; the effect of the enzyme-inducing activity of the original anticonvulsant 1-[(3-chlorophenyl)(phenyl)methyl]urea on the pharmacokinetic parameters of antipyrine in healthy volunteers. MATERIALS AND METHODS: 34 male patients were divided into three groups according to the nosological forms of diseases according to ICD-10: Group 1 — heading F43.23 and F43.25; 2 — F06.61; 3 — F41.2. Patients in the group 1 were prescribed alprazolam, in the 2 — bromazepam, in the 3 — lithium carbonate, for a course of 21 days. The comparison group consisted of 10 healthy volunteers. The original anticonvulsant was prescribed to the volunteers. Determination of the pharmacokinetics of antipyrine parameters as a test witness of the processes of elimination from the body was carried out in saliva before and after the end of therapy at a dose of 10 mg/kg once. RESULTS: Alprazolam administration by patients of group 1 at a dose of 0.5–1.5 mg/day for 21 days did not significantly affect the pharmacokinetic parameters of antipyrine: T1/2, Clt, AUC. Alprazolam did not change the elimination of antipyrine from the saliva of patients. In patients of the group2, who received bromazepam at a dose of 6–12 mg / day,a background decrease in T1/2, an increase in Clt, a decrease in AUC due to concomitant therapy were noted. Comparison of the pharmacokinetic parameters of antipyrine under the influence of bromazepam with background values not reveal significant differences. Therapy with lithium carbonate at a dose of 500–1000 mg/day in patients of the group 3 did not change the parameters of antipyrine elimination. The obtained data indicate that the drugs do not affect the activity of liver microsomal oxidation in patients. The study of the effect of 1-[(3-chlorophenyl)(phenyl)methyl]urea on the pharmacokinetic parameters of antipyrine in volunteers revealed a diametrically opposite result: a significant decrease in T1/2 by 2 times, an increase in Clt and a decrease in AUC, which indicates accelerated elimination of antipyrine from the saliva of the subjects and indicates the induction of liver microsomal oxidation. CONCLUSIONS: Pharmacotherapy using the studied psychotropic drugs in patients is not associated with the induction or inhibition of liver enzymes, which indicates the absence of drug pharmacokinetic interference. The original anticonvulsant 1-[(3-chlorophenyl)(phenyl)methyl]urea stimulated the induction of liver microsomal oxidation in volunteers.

Objective: To assess the agreement among three different online drug-drug interaction (DDI) checkers for the detection of psychotropic drug interactions among dental patients in the state of Minas Gerais, Brazil. Material and Methods: Between January and December 2017, a cross-sectional study was conducted in Minas Gerais with data on pharmaceutical claims of psychotropic drugs prescribed by dental practitioners. Data from the Pharmaceutical Management System provided the drug dispensing history of the patients, allowing the identification of those on concomitant medication use. The occurrence of DDI was determined by entering the name of the drugs taken by each patient into Merative Micromedex®, Medscape®, and DrugBank. The degree of agreement among the three DDI online checkers was analyzed using the Fleiss' kappa test. Results: Overall, 797 dental patients were found to be taking some psychotropic medication with other drugs simultaneously. The number of patients with DDI varied according to Micromedex® (n= 366), Medscape® (n= 473), and DrugBank (n= 736). The agreement between the DDI checkers was poor (Fleiss' kappa: 0.165; p<0.001). Conclusion: The online DDI checkers assessed in this study showed variations in their ability to detect interactions and poor agreement among them.

Abstract Background : Tobacco use is an epidemic known as “the brown plague” affecting one billion lives in the 21st century and 80% in developing countries. Prevalence of smoking is especially high in patients with psychiatric illness with an ongoing debate over which comes first. Studies about nicotine consumption in psychiatric patients are few from developing countries. Hence, this study is designed to identify socio-demographic and diagnostic correlates of nicotine use. Aims and Objectives :- To estimate the pattern of nicotine use and determine the association between socio-demographic profile, onset of nicotine use, it’s use as a coping mechanism, psychological association with nicotine use in psychologically ill patients. Material and methods :- A cross-sectional study including 101 patients with nicotine use and psychiatric illness were administered a semi structured questionnaire, Fagerstrom Test for Nicotine Dependence(FTND) and nicotine dependence syndrome scale. Data analyzed with mean, standard deviation, chi- square, ANOVA Results :-Nicotine use was more common in middle age group with alcohol dependence followed by depression. Nicotine use was not associated with background, socioeconomic status, gender. Majority tried to quit for health but what kept them with nicotine were drive, stereotypy, continuity, priority. Conclusions :- Nicotine is a commonly abused substance in psychiatric patients without a clear demarcation about the cause effect relationship. The existing study gives few insights into reasons for nicotine intake which was more so among the productive age group. Hence, there is a need for further research about psychotropic drug interactions with nicotine use and focus on integration of nicotine cessation into treatment of other psychiatric disorders rather than separate deaddiction clinics to alleviate the illness burden.

Background: Actual and potential drug–drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital during the months of February to July, 2021. Methods: The study is deductive, retroprospective, quantitative, applied, cross-sectional observational. The instrument used was a collection card for 86 pharmacotherapeutic follow-ups where psychotropic drugs for anxiety, depression and insomnia were registered. Results: In the actual and potential drug interactions of psychotropic drugs, according to the degree of severity dimension, it was identified that the important indicator represented the highest frequency of 89% of the interactions; according to the type of interaction dimension, it was identified that the pharmacodynamic indicator presented a higher frequency with 53%; according to the clinical evidence dimension, it was identified that the fair indicator had a higher frequency with 73% interactions; in the manifestation dimension, it was identified that the potential indicator presented a higher frequency with 92.2% interactions. In its moment of appearance dimension, it was identified that the quick indicator had a higher prevalence with 5.5% of real interactions. In its causality algorithm dimension, the probable indicator was identified as having the highest frequency with 7.25% of actual interactions. With respect to sex, the male presented 49.9% of potential interactions and in the real interactions, the female sex presented a higher incidence with 4.3% interactions. The average age of the potential interactions was 48.83 years, and the average age of the real interactions was 45.67 years. Sertraline presented 53.2% of potential interactions and in relation to real drug interactions the one that presented the highest frequency was mirtazapine with 3.5% interactions. Conclusion: We conclude that the increase in the prescription of psychotropic drugs is related to a higher probability of interactions.

Background: Psychotropic polypharmacy is particularly common, which puts psychiatric patients at high risk for developing drug-drug interactions. Objective: We aimed to study potential interactions between psychotropic medications prescribed within the outpatient psychiatry setting. Method: This was an audit study, which targeted a sample of outpatient prescriptions ordered within the outpatient clinics of the main psychiatry hospital in Bahrain over 2017. We studied the grades and correlates of interactions between psychotropic drugs. Results: The total number of prescriptions in our sample was 992 (56.1% males, 43.9% females). Psychotropic polypharmacy was detected in 842 prescriptions (84.9%). Potential interactions between psychotropic drugs were observed in 550 prescriptions (56.4%). The degree of interaction was minor in 43 prescriptions (7.8%), significant in 419 prescriptions (76.2%), and serious in 88 prescriptions (16%). Schizoaffective disorder subjects were the most likely to suffer from interactions (64.6%), whereas prescriptions issued for those who had schizophrenia contained the least number of interactions (51.6%). The total number of interactions was strongly associated with polypharmacy (p &lt; .001) and gender (p &lt; .01), but not with age (p &gt; .05) or diagnosis (p &gt; .05). Conclusion: High prevalence of polypharmacy and interactions between psychotropic medications were observed in our sample, particularly of the significant grade.

BackgroundDrug interactions are a significant issue in mental illnesses and coronavirus disease 2019 (COVID-19) infections. Inconsistency in drug interaction resources makes prescribing challenging for healthcare professionals. To assess the scope, completeness, and consistency of drug-drug interactions (DDIs) between psychotropic and COVID-19 medications in six specific drug information (DI) databases.MethodologyFor the comparison, six DI resources were used: Portable Electronic Physician Information Database, Micromedex®, Medscape.com, UpToDate®, Drugs.com drug interaction checker, and WebMD.com drug interaction checker. Using the Statistical Package for the Social Sciences (SPSS) software version 27 (IBM Corp., Armonk, NY), the gathered data were examined for scope, completeness, and consistency.ResultsScope scores were higher for PEPID© than all the other resources (p < 0.001) for each comparison. PEPID© had better overall completeness scores (median 5, Interquartile range [IQR] 5 to 5; p<0.05 for each comparison), except for Drugs.com (p < 0.05 for each comparison), and were more remarkable for Micromedex® (median 5, IQR 5 to 5). The Fleiss kappa scores among the six different DI sources were poor (k < 0.20, p < 0.05) for the category of information related to clinical effects and level of documentation, moderate agreement (k = 0.4 - 0.6, p < 0.05) for the severity and course of action of DDIs, and fair agreement (k = 0.4 - 0.6, p < 0.05) for mechanism.ConclusionA comprehensive, accurate information among DI resources is essential for healthcare professionals that will significantly impact patient care in the clinical practice. Banking on high-quality resources will help healthcare professionals to make an informed decision while prescribing to avoid inappropriate combinations that can adversely affect patient outcomes.

In mental patients with concomitant somatic pathology, psychotropic drugs are prescribed in combination with other drugs used in the treatment of various somatic diseases. As well as a large number of patients with somatic diseases, they receive therapy aimed at correcting mental disorders. At the same time, it is important to take into account the possibility of cross-influence of such pharmacotherapy on the functions of the central nervous system and internal organs, as well as the peculiarities of drug interactions between drugs. According to the mechanism of development, there are pharmaceutical, pharmacokinetic and pharmacodynamic interactions of drugs. The result of the interaction of drugs is more often a change in the intensity of the effect of drugs, less often there are qualitative changes in their action. The review article provides up-to-date practical information on the interaction of drugs for the treatment of mental disorders with drugs of other groups.

ABSTRACT Using psychiatric drugs to treat drug dependence and its comorbidities is very common. The objective of this study was to analyze the interactions between prescribed drugs for patients treated at a specialized mental health-care center for persons who use drugs, located in the state of Santa Catarina, Brazil. A cross-sectional study was conducted on secondary data collected from 2010 to 2018. We reviewed the medical records of patients aged 18 years or older who took psychotropic drugs and had any type of substance dependence. The analysis of psychotropic drug interactions was conducted in three databases: Medscape, Drug Interactions Checker, and Micromedex. We included 1,022 of the 2,322 patients attending the care center during the study period. Psychotropic drug interactions were found in 779 (76.4%) study participants, and they presented 2,292 (100%) interactions, out of which 136 (6.0%) had minor clinical risk, 537 (23.4%) had moderate risk, and 1,619 (70.6%) had major risk for the patient, totaling 172 incompatible combinations between two psychotropic drugs. Of the total number of interactions, 128 were pharmacokinetic and 44 were pharmacodynamic. The high number of psychotropic drug interactions is a serious public health issue. Psychopharmacological treatment should be carefully addressed to be safe for the patient.

P.490 Potential cytochrome P450 psychotropic drug interactions in an in-patient psychiatric population.

Abstract Background Using psychiatric drugs to treat drug dependence and its comorbidities is very common. The objective of this study was to analyze the interactions between prescribed drugs for patients treated at a specialized mental health care center for drug addicts, located in southern Brazil. Methods A cross-sectional study was conducted on secondary data collected from 2010 to 2018. We reviewed the medical records of patients aged 18 years or older who took psychotropic drugs and had any type of substance dependence. The analysis of psychotropic drug interactions was conducted in three databases: Medscape, Drug Interactions Checker, and Micromedex. Results We included 1,022 of the 2,322 patients attending the care center during the study period. Psychotropic drug interactions were found in 779 (76.4%) study participants, and they presented 2,292 (100%) interactions, out of which 136 (6.0%) had minor clinical risk, 537 (23.4%) had moderate risk, and 1,619 (70.6%) had major risk for the patient, totaling 172 incompatible combinations between two psychotropic drugs. Of the total number of interactions, 128 were pharmacokinetic and 44 were pharmacodynamic. Conclusions The high number of psychotropic drug interactions is a serious public health issue. Psychopharmacological treatment should be carefully addressed to be safe for the patient. Key messages The implementation of clinical pharmacy services in outpatient clinics, hospitals, and mental health care centers can be considered the most effective alternative to avoid adverse reactions. Pharmacists are ready to assist the entire multidisciplinary team involved in the treatment of patients with mental disorders or substance dependence, and provide pharmacological treatment.

Objective: The rate of polypharmacy is increasing in patients with psychotic disorders. Polypharmacy is defined as the concomitant use of two or more drugs at a time. As most psychotropic medicatio...

Background The number of psychotropic drugs has expanded tremendously over the past few decades with a proportional increase in drug-drug interactions. The majority of psychotropic agents are biotransformed by hepatic enzymes, which can lead to significant drug-drug interactions. Most drug-drug interactions of psychotropics occur at metabolic level involving the hepatic cytochrome P450 enzyme system. Methods We searched the National Library of Medicine, PsycINFO, and Cochrane reviews from 1981 to 2012 for original studies including clinical trials, double-blind, placebo-controlled studies, and randomized controlled trials. In addition, case reports, books, review articles, and hand-selected journals were utilized to supplement this review. Results Based on the clinical intensity of outcome, cytochrome interactions can be classified as severe, moderate, and mild. Severe interactions include effects that might be acutely life threatening. They are mainly inhibitory interactions with cardiovascular drugs. Moderate interactions include efficacy issues. Mild interactions include nonserious side effects, such as somnolence. Conclusions Psychotropic drugs may interact with other prescribed medications used to treat concomitant medical illnesses. A thorough understanding of the most prescribed medications and patient education will help reduce the likelihood of potentially fatal drug-drug interactions.

Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite the increasing use of concomitant therapy in children and adolescents, there is very little evidence from controlled clinical trials to provide guidance for prescribers. Even while acknowledging the small evidence base, clinical practice guidelines from eminent medical organizations are either relatively silent on or tend to support the use of concomitant treatments more enthusiastically than the evidence would warrant, so that practice and guidance are running ahead of the science. Our narrative review shows that the published evidence for efficacy and safety of concomitant psychotropic drugs in children and adolescents is scanty. A comprehensive search located 37 studies published over the last decade, of which 18 were randomized controlled trials (RCTs). These focused mainly on stimulants, central sympatholytics (such as clonidine), antipsychotics and 'mood stabilizers'. While several small, often methodologically weak, RCTs demonstrated statistically significant advantages for dual pharmacotherapy over monotherapy, only adding central sympatholytics to stimulants for treating attention-deficit hyperactivity disorder (ADHD) symptoms was supported by substantial studies with an effect size large enough to suggest clinical importance. Non-randomized studies tended to have results that supported concomitant treatment, but all have design-related problems that decrease the reliability of the results. Two studies that specifically examined tolerability of combination pharmacotherapy compared with monotherapy showed significant increases in adverse effects, both subjective and objective, and other studies confirmed a statistically significant increase in adverse effects, including sedation and self-harm. Given the extent of combination therapy occurring, particularly in conditions such as ADHD, and the ambiguous evidence for benefit with clear evidence of harm, we propose that further research should be carried out as a matter of urgency. Until such a time, the attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an 'n of 1' trial to be closely monitored.

This toolbox on the next page is meant to be used as a quick reference when determining the level of evidence for and severity of drug interactions between antiretroviral therapy and psychotropic medications. A key is included describing each level of evidence and the various colors used in the document.As you are working with individuals living with mental illness, you will find the NAMI Medication Fact Sheets developed by CPNP members to be helpful in educating your patients about their medications.Key for level of evidenceColor code

Multidrug resistance P-glycoprotein (P-gp; also known as MDR1 and ABCB1) is expressed in the luminal membrane of the small intestine and blood-brain barrier, and the apical membranes of excretory cells such as hepatocytes and kidney proximal tubule epithelia. P-gp regulates the absorption and elimination of a wide range of compounds, such as digoxin, paclitaxel, HIV protease inhibitors and psychotropic drugs. Its substrate specificity is as broad as that of cytochrome P450 (CYP) 3A4, which encompasses up to 50% of the currently marketed drugs. There has been considerable interest in variations in the ABCB1 gene as predictors of the pharmacokinetics and/or treatment outcomes of several drug classes, including antidepressants and antipsychotics. Moreover, P-gp-mediated transport activity is saturable, and is subject to modulation by inhibition and induction, which can affect the pharmacokinetics, efficacy or safety of P-gp substrates. In addition, many of the P-gp substrates overlap with CYP3A4 substrates, and several psychotropic drugs that are P-gp substrates are also CYP3A4 substrates. Therefore, psychotropic drugs that are P-gp substrates may cause a drug interaction when P-gp inhibitors and inducers are coadministered, or when psychotropic drugs or other medicines that are P-gp substrates are added to a prescription. Hence, it is clinically important to accumulate data about drug interactions through studies on P-gp, in addition to CYP3A4, to assist in the selection of appropriate psychotropic medications and in avoiding inappropriate combinations of therapeutic agents. There is currently insufficient information available on the psychotropic drug interactions related to P-gp, and therefore we summarize the recent clinical data in this review.

Besides the three antidepressant-sensitive, Na(+)- and Cl(-)-dependent monoamine transporters, Na(+)-independent organic cation transporters (OCTs) are known to transport monoamines. However, little is known about the interactions of psychotropic drugs with human (h) OCTs. In the present study, a series of diverse antidepressant and antipsychotic drugs were examined for their inhibitory potency at hOCT1, hOCT2 and hOCT3 by measuring inhibition of [(3)H]-MPP(+) uptake into HEK293 cells stably expressing one of the three hOCTs. The inhibitory potencies (IC(50)s) ranged from 1 to 900μM. Most of the examined drugs showed highest inhibitory potency at hOCT1 which is very sparsely expressed in the brain and mainly involved in renal and hepatic clearance of cationic drugs. At their upper therapeutic plasma concentrations, several drugs are expected to inhibit by more than 20% hOCT1 and could thus interfere with the pharmacokinetics of hOCT1-transported drugs in the kidney and liver, namely trimipramine, desipramine and fluoxetine (by about 37%), levomepromazine and nefazodone (by about 32%), and clozapine and amitriptyline (by about 22%). At hOCT2 and hOCT3, which are involved in monoamine homeostasis in the brain, IC(50)s of most psychoactive drugs were in the high micromolar range. At their upper plasma concentrations, only three compounds, bupropion, nefazodone and clozapine, showed potential for inhibition, of about 18% at hOCT2 (bupropion), about 22% at hOCT3 (nefazodone) and of approximately 10% at hOCT2 and hOCT3 (clozapine). Thus, under the assumption of a tenfold accumulation in the brain, bupropion, nefazodone and clozapine may notably inhibit the corresponding hOCTs. It remains to be shown whether such a direct inhibition plays a role in the clinical effects of these three drugs.