Psychotropic Drug Interactions Research Articles

Pattern Of Nicotine Use And Dependence In Psychiatric Patients

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.

Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021

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.

Potential Psychotropic and COVID-19 Drug Interactions: A Comparison of Integrated Evidence From Six Database Programs.

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.

Topical issues of interaction of psychotropic drugs

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.

Potential Psychotropic Drug Interactions among Drug-dependent People

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.

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

Psychotropic drug interactions among drug-dependent people

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.

Risk of Psychotropic Drug Interactions in Real World Settings: a Pilot Study in Patients with Schizophrenia and Schizoaffective Disorder

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...

Combination Pharmacotherapy for Psychiatric Disorders in Children and Adolescents: Prevalence, Efficacy, Risks and Research Needs

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.

HAART and psychotropic drug interactions toolbox

HAART and psychotropic drug interactions toolbox

Psychotropic Drug–Drug Interactions Involving P-Glycoprotein

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.

Interaction of antidepressant and antipsychotic drugs with the human organic cation transporters hOCT1, hOCT2 and hOCT3

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.

Clinically significant psychotropic drug-drug interactions in the primary care setting.

In recent years, the growing numbers of patients seeking care for a wide range of psychiatric illnesses in the primary care setting has resulted in an increase in the number of psychotropic medications prescribed. Along with the increased utilization of psychotropic medications, considerable variability is noted in the prescribing patterns of primary care providers and psychiatrists. Because psychiatric patients also suffer from a number of additional medical comorbidities, the increased utilization of psychotropic medications presents an elevated risk of clinically significant drug interactions in these patients. While life-threatening drug interactions are rare, clinically significant drug interactions impacting drug response or appearance of serious adverse drug reactions have been documented and can impact long-term outcomes. Additionally, the impact of genetic variability on the psychotropic drug's pharmacodynamics and/or pharmacokinetics may further complicate drug therapy. Increased awareness of clinically relevant psychotropic drug interactions can aid clinicians to achieve optimal therapeutic outcomes in patients in the primary care setting.

Interaction of psychotropic drugs with monoamine oxidase in rat brain.

Literature observations indicate that some psychotropic drugs may have inhibitory activity towards monoamine oxidase (MAO). This study was undertaken to assess the potency, isozyme selectivity and mechanism of inhibition of representative first- and second-generation antidepressant drugs towards rat brain MAO-A and MAO-B. Five tricyclic antidepressants (imipramine, trimipramine, clomipramine, amitriptyline and doxepine) and three selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine and citalopram) were examined. They showed inhibitory activity towards MAO-A and MAO-B, with clear selectivity for MAO-B (Ki in the micromolar range). Their mechanism of inhibition was competitive towards MAO-B and of a mixed competitive type towards MAO-A. The results suggest that some of the drugs examined might also contribute an MAO inhibitory effect in chronically treated patients.

Handbook of Clinical Psychopharmacology for Therapists, 4th ed

This book ended up being more than I expected. I was anticipating a handy reference source for commonly used psychotropic medications, which it is, but that is only part of what makes this a useful and valuable resource tool. The Handbook of Clinical Psychopharmacology for Therapists is logically organized into 3 major sections. The first, “Understanding Psychopharmacology: The Basics,” is easily the most academic of the three. Liberal use of case histories and sidebars with interesting anecdotal information, however, make it surprisingly readable and user-friendly. The second section, “Clinical Syndromes: Etiology, Diagnosis, and Treatment Implications,” is the largest and most clinical segment. In it the reader will find a comprehensive list and description of the most common psychiatric disorders. Included in these descriptions are helpful suggestions regarding possible drugs and medical conditions that cause similar behavioral patterns as well as guidelines for when nonmedical practitioners should consider referral for medication treatment. The third section, “Medications and Pharmacologic Treatment,” contains the information that I was initially looking for. Again the authors organize their material in a logical and clinically useful manner on the basis of major drug categories. They also provide handy thumb-tabs along with numerous charts and tables relating to issues such as dose guidelines, common side effects, special considerations, and treatment algorithms. I particularly appreciate their inclusion of a review on over-the-counter and herbal products, an area of increasing interest in recent years. This third section is what will make this text a frequent reference source for me and is the reason I plan to keep it on my desk rather than in my bookcase. The book ends with 8 appendices intended for readers looking for a more in-depth discussion of topics mentioned earlier in the book. Included here are an expanded review of pharmacokinetics, numerous tables listing psychotropic drug interactions, an outline for performing a neurocognitive mental status exam, and a reference list of books to recommend to patients. All in all, the Handbook of Clinical Psychopharmacology for Therapists is a well-written text that is capable of providing the reader with comprehensive review information as well as quick reference assistance.

Quantifying Drug-Drug Interactions in Pharmaco-EEG

A drug interaction refers to an event in which the usual pharmacological effect of a drug is modified by other factors, most frequently additional drugs. When two drugs are administered simultaneously, or within a short time of each other, an interaction can occur that may increase or decrease the intended magnitude or duration of the effect of one or both drugs. Drugs may interact on a pharmaceutical, pharmacokinetic or pharmacodynamic basis. Pharmacodynamic interactions arise when the alteration of the effects occurs at the site of action. This is a wide field where not only interactions between different drugs are considered but also drug and metabolites (midazolam/alpha-hydroxy-midazolam), enantiomers (ketamine), as well as phenomena such as tolerance (nordiazepam) and sensitization (diazepam). Pharmacodynamic interactions can result in antagonism or synergism and can originate at a receptor level (antagonism, partial agonism, down-regulation, up-regulation), at an intraneuronal level (transduction, uptake), or at an interneuronal level (physiological pathways). Alternatively, psychotropic drug interactions assessed through quantitative pharmaco-EEG can be viewed according to the broad underlying objective of the study: safety-oriented (ketoprofen/theophylline, lorazepam/diphenhydramine, granisetron/haloperidol), strictly pharmacologically-oriented (benzodiazepine receptors), or broadly neuro-physiologically-oriented (diazepam/buspirone). Methodological issues are stressed, particularly drug plasma concentrations, dose-response relationships and time-course of effects (fluoxetine/buspirone), and unsolved questions are addressed (yohimbine/caffeine, hydroxizyne/alcohol).

P.3.c.009 Valproate and psychotropic drug interactions

P.3.c.009 Valproate and psychotropic drug interactions

Psychotropic drug versus psychotropic drug—update

Psychotropic drugs are not necessarily the drugs of psychiatry. Seventy percent of antidepressants, and 90% of anxiolytics are prescribed by nonpsychiatric physicians. Since psychotropic medications are so frequently employed by nonpsychiatric physicians, e.g., neurologists, primary care physicians, internists, and because large numbers of their patients are concurrently on medical drugs for somatic reasons, the interactions of psychotropic versus medical drugs and psychotropic versus psychotropic drugs as listed below must be understood before primary care physicians or psychiatrists prescribe psychotropic medications, especially to the medically ill. Seventy commonly prescribed psychotropic drugs were examined for their interactions with other psychotropic medications using six reference tools: 1) MEDLINE (PubMed) employing the first generic psychotropic drug name, the second generic psychotropic drug name, and the term “interaction;” 2) Hanston's Drug Interaction Analysis and Management Text (quarterly updated version) [2]; 3) Drug Interactions Facts (Facts and Comparisons) (July 2001 quarterly updated version) [3]; 4) Micromedex Drug-dex [4]; 5) American Hospital Formulary Service Drug Information [5]; and 6) Food and Drug Administration (MedWatch) (Dear Doctor Letters and new labeling) ( www.fed.gov/medwatch for (1999, 2000, and 2001). The authors recognized that all of the above sources do not necessarily cover the entire information database regarding drug–drug interactions. (Citations regarding children, reports in foreign languages or concerning food, animals, in vitro experiments, analgesics, and naturalistic—herbal or natural products—treatment interactions were excluded).

Cardiac drug-psychotropic drug update

This is an update from the report—Cardiac Drug and Psychotropic Drug Interactions: Significance and Recommendations-published in this journal in November-December 1999. As mentioned in that article there has been an explosion of new drugs both in psychiatry and cardiology without a sufficient understanding of their potential interactions. Also there is a need for methods to update drug interactions on an ongoing basis. This report describes: 1) examples of actual adverse interactions from clinical cases that move beyond some of the hypothesized contraindications included in the 2000 millennium publication; 2) confirmation of previous adverse interactions reported if they strengthen the earlier findings; 3) listing of new drugs, e.g., sildenafil (viagra) now commonly prescribed by psychiatrists and cardiologists; 4) reports explaining and/or refining mechanisms of adverse interactions; and 5) cautions and important associated phenomenon of either a cardiac or a psychotropic drug, e.g., valproic acid and cases of life-threatening pancreatitis. Methods of publicizing the new knowledge of cardiac drug-psychotropic drug interactions, e.g., the Internet and web sites are described.

Cardiac drug–psychotropic drug update

This is an update from the report—Cardiac Drug and Psychotropic Drug Interactions: Significance and Recommendations—published in this journal in November-December 1999. As mentioned in that article there has been an explosion of new drugs both in psychiatry and cardiology without a sufficient understanding of their potential interactions. Also there is a need for methods to update drug interactions on an ongoing basis. This report describes: 1) examples of actual adverse interactions from clinical cases that move beyond some of the hypothesized contraindications included in the 2000 millennium publication; 2) confirmation of previous adverse interactions reported if they strengthen the earlier findings; 3) listing of new drugs, e.g., sildenafil (viagra) now commonly prescribed by psychiatrists and cardiologists; 4) reports explaining and/or refining mechanisms of adverse interactions; and 5) cautions and important associated phenomenon of either a cardiac or a psychotropic drug, e.g., valproic acid and cases of life-threatening pancreatitis. Methods of publicizing the new knowledge of cardiac drug–psychotropic drug interactions, e.g., the Internet and web sites are described.