Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021 (original) (raw)
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Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 2023
Objective: COVID-19 has gravely affected patients with psychiatric conditions. Potential interactions may occur between psychotropic medications and medications used in treatment of COVID-19. This study aimed to compare the online databases in terms of the quality of drug-drug interaction related information available on them. Methods: 216 drug interactions which included fifty-four psychotropic medication interactions with four COVID-19 drugs across six databases were analyzed by four authors independently. The overall grading of the databases was done on Likert scale independently by the authors using the parameters of ease of understanding for consumers and professionals, level of completeness, discussion on level of evidence and the number of available drugs, congruity with other databases and the mean score was tabulated. Results: Drugbank and Lexicomp had maximum discrepancy. The safety profile of Hydroxychloroquine was the best (eighteen moderate/severe psychotropic medication reactions) while Ritonavir has worst profile with thirty-nine medications. Drugbank had the highest SCOPE score (1.00) for completeness and covid19druginteractions.com had least (0.81). Overall, Liverpool © Drug Interaction Group and Lexicomp scored the highest (23/30 each) and were the best interaction checker software closely followed by Drugs.com (22/30). Medscape and WebMD were the poorest interaction checker databases. Conclusion: There is significant variability in the available online databases. Liverpool © Drug Interaction Group and Lexicomp were the most reliable sources for healthcare workers whereas for patients, Drugs.com was the easiest to understand (as it segregates the needs of general consumers and professionals distinctly to explain the interaction).
Cureus, 2021
Background Drug 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. Methodology For 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. Results Scope 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. Conclusion A 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.
Journal of Young Pharmacists, 2018
Background: In the mental health field, the psychotropic polypharmacy is frequently observed, a significant risk factor for the occurrence of drug interactions. Objective: Identify potential drug interactions on the prescriptions of mental health services users and describe the associated factors. Methods: A cross-sectional study was conducted in 11 services. Sociodemographic data and information about the use of drug were obtained through interviews of users, analysis of prescriptions and medical charts, using a semi-structured questionnaire. Potential drug interactions were identified using the Micromedex® database, the association with sociodemographic characteristics and aspects related to the medicines prescribed were analyzed using the prevalence ratio. Results: The number of medicines prescribed ranged from 0 to 9, with an average of 3.38 (SD=1.76) per user, the most prescribed being haloperidol (12.3%), clonazepam (8.2%) and biperiden (7.9%). The proportion of interactions considering the number of users interviewed was 35.1%. The most frequent between potential interactions were haloperidol and fluoxetine (9.1%); haloperidol and carbamazepine (8.8%); and carbamazepine and chlorpromazine (5.9%). The highest prevalence ratio (PR) for the occurrence of potential interactions was in women (PR=1.36; 95% CI 1.08:1.71), users who had reported improper medicine use (PR=1.36; 95% CI: 1.07:1.72) and those with more than 5 prescribed medicines (PR=1.87; 95% CI: 1.49:2.33). Conclusion: Potential drug interactions were observed in more than one-third of the user's Brazilian mental health services. The profile of interactions detected could guide the pharmacotherapeutic follow-up of priority users, and help the multidisciplinary team identify signs and symptoms that can influence the treatment of users.
Comparison of three methods for identifying medical drug-psychotropic drug interactions
General Hospital Psychiatry, 2002
Three methods for examining drug-drug interactions were compared to understand advantages and disadvantages of each: ePocrates; Interact; The Mount Sinai multiple source for the evaluation of drug-drug interactions (MS). ePocrates is a commonly employed software system utilized in a hand held computer, the PalmPilot. Interact is on a CD-ROM, and promoted by the American Psychiatric Association Press. The MS system was developed by the authors and utilizes six separate references sources to ascertain the presence and significance of drug-drug interactions. Commonly prescribed neurology and psychotropic medication interactions were compared using the three systems. ePocrates did not list the significance level of the interaction, e.g., (major, moderate, minor), often did not include a mechanism of action, and several commonly employed medications were not included. It did permit examining several drugs at the same time, and was easily carried on the person of the physician. Interact often contained old references, several drugs were not included, was not adapted to a hand held computer format, and had no update since 1999. The MS system listed level of significance, provided mechanism of action , and advice to the practitioner including recommendations. It is not portable, requiring a laptop or desk top computer or hard copy, and only searches one drug at a time. It is hoped that the advantages of each of these three systems may be incorporated into systems of the future.
Research Paper: Drug Interactions of Psychiatric and COVID-19 Medications
2020
Introduction: Coronavirus disease 2019 (COVID-19) has become a pandemic with 1771514 cases identified in the world and 70029 cases in Iran until April 12, 2020. The co-prescription of psychotropics with COVID-19 medication is not uncommon. Healthcare providers should be familiar with many Potential Drug-Drug Interactions (DDIs) between COVID-19 therapeutic agents and psychotropic drugs based on cytochrome P450 metabolism. This review comprehensively summarizes the current literature on DDIs between antiretroviral drugs and chloroquine/hydroxychloroquine, and psychotropics, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Methods: Medical databases, including Google Scholar, PubMed, Web of Science, and Scopus were searched to identify studies in English with keywords related to psychiatric disorders, medications used in the treatment of psychiatric disorders and COVID-19 medications. Results: There is a great potential for DDIs between psychiatric and COVID-19 medications ranging from interactions that are not clinically apparent (minor) to those that produce lifethreatening adverse drug reactions, or loss of treatment efficacy. The majority of interactions are pharmacokinetic interactions via the cytochrome P450 enzyme system. Conclusion: DDIs are a major concern in the comorbidity of psychiatric disorders and COVID-19 infection resulting in the alteration of expected therapeutic outcomes. The risk of toxicity or lack of efficacy may occur due to a higher or lower plasma concentration of medications. However, psychiatric medication can be safely used in combination with COVID-19 pharmacotherapy with either a wise selection of medication with the least possibility of interaction or careful patient monitoring and management.
Drug Interactions of Psychiatric and COVID-19 Medications
Basic and Clinical Neuroscience Journal, 2020
Coronavirus disease 2019 (COVID-19) has become a pandemic with 1771514 cases identified in the world and 70029 cases in Iran until April 12, 2020. The co-prescription of psychotropics with COVID-19 medication is not uncommon. Healthcare providers should be familiar with many Potential Drug-Drug Interactions (DDIs) between COVID-19 therapeutic agents and psychotropic drugs based on cytochrome P450 metabolism. This review comprehensively summarizes the current literature on DDIs between antiretroviral drugs and chloroquine/hydroxychloroquine, and psychotropics, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Methods: Medical databases, including Google Scholar, PubMed, Web of Science, and Scopus were searched to identify studies in English with keywords related to psychiatric disorders, medications used in the treatment of psychiatric disorders and COVID-19 medications. Results: There is a great potential for DDIs between psychiatric and COVID-19 medications ranging from interactions that are not clinically apparent (minor) to those that produce lifethreatening adverse drug reactions, or loss of treatment efficacy. The majority of interactions are pharmacokinetic interactions via the cytochrome P450 enzyme system. Conclusion: DDIs are a major concern in the comorbidity of psychiatric disorders and COVID-19 infection resulting in the alteration of expected therapeutic outcomes. The risk of toxicity or lack of efficacy may occur due to a higher or lower plasma concentration of medications. However, psychiatric medication can be safely used in combination with COVID-19 pharmacotherapy with either a wise selection of medication with the least possibility of interaction or careful patient monitoring and management.
Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 2019
The risk of drug interaction (DI), especially in the hospital setting, increases along with the number of drugs used by the patient. Studies that evaluate drug interactions based on patient prescriptions are therefore useful to know this risk and guide strategies to improve drug use. The present study is aimed to identify studies that evaluated DI in patients of Brazilian hospitals. As of bibliographic search in several databases, we collected articles describing prescribing evaluations which focused on the analysis and identification of drug interactions in Brazilian hospitals. The search was conducted in 2017 and there was no restriction of publication time. Of a total of 273 articles retrieved, 23 were included for analysis. Most was published after 2010, and the predominant design was cross-sectional studies. The Micromedex® database was the most used to categorize the interactions, and midazolam and fentanyl was the most commonly reported potential DI in the studies. The result...
Iranian Journal of Pharmaceutical Research : IJPR, 2021
Coronavirus disease 2019 (COVID-19) management in patients with predisposing psychiatric disorders would be challenging due to potential drug-drug interactions (PDDIs) and precipitation of their disease severity. Furthermore, COVID-19 itself might precipitate or induce unpredicted psychiatry and neuropsychiatry complications in these patients. In this literature review study, the psychological impacts of COVID-19 and major psychiatric adverse drug reactions (ADRs) of COVID-19 treatment options have been discussed. A detailed Table has been provided to assess potential drug-drug interactions of COVID-19 treatment options with psychotropic medications to avoid unwanted major drug-drug interactions. Finally, potential mechanisms of these major drug-drug interactions and possible management of them have been summarized. The most common type of major PDDIs is pharmacokinetics. Hydroxychloroquine/chloroquine and lopinavir/ritonavir were the most involved anti-COVID-19 agents in these majo...
2021
Introduction: older patients usually had multiple diseases and so use many medicines. The elevated risks of pharmacotherapy in this population justified the development of ratings for unsafe medicines. Objective: to estimate the prevalence of potential drug interactions of clinical importance in primary health care and its associated factors, improving prescription practices and increasing patient safety. Methods: a cross-sectional study of dependent variable "number of potential drug-drug interactions of clinical importance", in all medicines and patients who accessed medicines via public primary health care, 2013. The independent variables were socio demographic, accessibility of health services and pharmacotherapy. Multivariate analyses were performed using the Statistical Learning Theory with Exaustive-CHAID algorithm, with test Pearson's chi-square adjusted by the Bonferroni method. Results: a total of 4,037 patients were included in this study and the patient prevalence of at least one drug-drug interaction was 36.5% with severity moderate (66.2%) or major (28.5%). The most prevalent conduct for management of them were monitor the patient (59.0%), adjust the dosage of the medicines (21.9%) and monitoring signs and symptoms (16.7%). In the multivariate analysis by the Theory of Statistical Learning when we compared the "patients who had at least one drug interaction of clinical importance" with those who did not have them at the first hierarchical level of relevance, the variable "number of drugs in use" prevailed with a p value <0.0001. The analysis also proposed 7 different risk strata to explain the distinction between having at least one interaction of clinical importance, namely: 1, 2, 3, 4, 5, 6-7 and> 8 drugs. When comparing patients with 2 medications and those with 8 or more medications, the prevalence of drug interactions increases by about 80%. Using polypharmacy (5 or more drugs) as the cutoff point to make the same comparison, the increase is about 45%. Other variables with statistical relevance to explain having or not having hair were "multiple drug dispensations per month" (p = 0.003 and p = 0.01) and "being elderly" (p = 0.003). Having "multiple drug dispensations per month" reduced the prevalence of interactions by about 10% for both patients with 3 medications (p = 0.003) and those with 6 or 7 medications. Conclusions: the drug-drug interactions showed be different in primary care of hospitals and other place for health care. And the number of medications in use by the patient seems to be the main marker for patient selection for this type of analysis, with polypharmacy being a relevant cutoff point, but above all the use of 8 or more medications indicates a prevalence of more than 90% patients of at least one interaction of clinical importance. There are few studies of potential drug-drug interactions in public primary health care, especially with analysis of the severity and management of them. We recommend more studies for clarify prevalence, types and associated factors.
Objective: To assess the compliance of medical prescriptions containing psychotropic drugs and potential drug interactions. Methods: This descriptive cross-sectional study was conducted at Jamot Hospital in Yaounde (Cameroon) from March to May 2018. Medical prescriptions were collected consecutively at the hospital's in-house pharmacy, and only those containing at least one psychotropic drug were retained. The date, the identity of the prescriber and the patient, as well as information about the medication were searched. Potential drug interactions were analysed using two drug interaction checking software programs: Medscape and Drugbank. Results: One hundred and thirty-four (134) prescriptions were collected and 20 (14.92%) contained at least one psychotropic drug and all were written on simple prescriptions. The following were present: date (100%), registration number in the National Order of Doctors in Cameroon (25%), prescriber's address (30%), patient's name (95%), age (65%), sex (35%), weight (0%), dosage (85%), galenic form (90%), unit of intake (90%), frequency of intake (85%), duration of treatment (l0%), mention of "to be renewed or not" (1%). Almost 80% of the prescriptions contained at least 3 potential drug interactions, of which 72.88% were pharmacodynamic and 27.11% pharmacokinetic. The potential drug interactions identified were type C (91.52%), D (5.08%) and B (3.39%). Conclusion: None of the prescriptions complied with the rules for prescribing psychotropic drugs and almost all the potential drug interactions identified were moderate.