Retrospective cohort observation on psychotropic drug-drug interaction and identification utility from 3 databases: Drugs.com®, Lexicomp®, and Epocrates®
Ravi Pinkoh, Ratchanee Rodsiri, Sorawit Wainipitapong
Background
Pharmacotherapy is necessary for many people with psychiatric disorders and polypharmacy is common. The psychotropic drug-drug interaction (DDI) should be concerned and efficiently monitored by a proper instrument.
Objectives
This study aimed to investigate the prevalence and associated factors of psychotropic DDI and to compare the identification utility from three databases: Drugs.com®, Lexicomp®, and Epocrates®.
Methods
This was a retrospective cohort design. We collected demographic and clinical data of all patients hospitalised in the psychiatric inpatient unit in 2020. Psychotropic DDI profiles were examined through three databases. Descriptive statistics were used to report comprehensiveness of each database and prevalence of psychotropic DDI. The Fleiss’ kappa index would be analysed to indicate agreement strength of DDI severity classification among three databases.
Results
From 149 total admissions, the psychotropic DDIs were found in 148 admissions (99.3%). Thorough the study, there were 182 of both psychotropic and other agents prescribed under 1,357 prescriptions. In total, 2,825 psychotropic DDIs were identified by using Drugs.com® 2,500 times, Epocrates® 2,269 times, and Lexicomp® 2,265 times. Interactions with clonazepam was the three most frequent agents when co-administrated with quetiapine (n = 56), risperidone (n = 36), and valproic acid and derivatives (n = 36). Serious DDIs were comparatively lower in incidence and there was no evidence of its association with reported clinical adverse consequences.
Background
Psychiatric disorders are among the most leading causes of burden globally and the number of patients with mental illnesses has been continuously increasing [1]. According to complex neurobiological aetiologies of several mental disorders, pharmacological treatments are commonly used and novel treatments, targeting on multidimensional of the pathophysiology, have been developed [2]. However, some patients who are unresponsive to standard treatment tend to be prescribed for multiple classes of psychotropic medication to reduce their symptoms [3]. Thus, the higher risks of psychotropic drug-drug interaction (DDI) are inevitable.
Apart from various psychiatric symptoms requiring different psychopharmacological actions, longer life expectancy, followed by further medical comorbidities, also warrants polypharmacy and increases risks of psychotropic DDIs [4]. Numerous previous studies have shown high prevalence of DDIs in various settings, either clinical or non-clinical, including nursing home (81.1%), community pharmacies (26.0–49.6%), inpatient and outpatient department of the hospital (22.3%) [5–7]. Despite the observed association between DDIs and clinical outcomes such as hospitalisation or hospital visits, only a few patients clinically manifested complications from DDIs [8, 9]. Nowadays, healthcare technology systems have been implemented to detect DDIs, but too frequent, false and unnecessary alarms can have negative effects on both providers’ exhaustion and patients’ safety [10]. Therefore, the multidisciplinary team should consider an appropriate instrument to identify clinically significant DDIs under the balance between alarm fatigue and patient safety.
Material and methods
This study was a retrospective cohort design. We extracted data from the electronic health records of all patients hospitalised during 2020 in the psychiatric inpatient unit at one university hospital in Bangkok, Thailand. The records included all pharmacological prescriptions which were recorded and followed from the first day of admission till the date of discharge or the end of our study. The psychotropic DDI was identified by three different databases. We analysed the association between psychotropic DDI and clinical outcomes, including recorded adverse drug events, length of hospitalisation, and readmission. The informed consent was not obtained because we collected data from service records and report anonymously. All patients with age over than 18 years old were included, thus neither sample size calculation nor sampling was done in this study. This study was granted the ethical approval from the Institutional Review Board of Faculty of Medicine, Chulalongkorn University.
Results
Throughout the study, there were 149 psychiatric admissions from 128 patients. Most patients were female (n = 75, 58.6%), diagnosed with schizophrenia spectrum disorders (n = 42, 32.8%), and averagely at 39.4 ± 18.8 years of age (min–max = 19–86 years old). All 1,357 prescriptions during the study period were assessed. In total, 176 individual agents of either psychotropic or other medications were prescribed. Three most frequently prescribed psychotropic agents were clonazepam (n = 109, 8.0%), quetiapine (n = 82, 6.0%), and haloperidol (n = 64, 4.7%). Seven patients (5.5%) reported history of adverse drug reactions and sixteen patients (12.5%) were readmitted within a year.
Discussion
The psychotropic DDI occurred in nearly all psychiatric admissions. Interestingly, the only admission without psychotropic DDI was a patient admitted for drug dependence rehabilitation and prescribed for vitamin supplements and supportive therapies. Our findings confirmed the high prevalence of psychotropic DDIs detected by electronic databases in the psychiatric inpatient settings [21, 22].
However, the median of number of medications prescribed during hospitalisation was 9 and this limited its generalisability with patients in the psychiatric outpatient department, where the number of medications prescribed was comparatively lower [23]. Due to the nature of quaternary hospital services, patients in our institute often had more complicated medical comorbidities and then were at higher risk for psychotropic DDIs.
Conclusion
Almost all patients hospitalised in the psychiatric inpatient unit had at least one psychotropic DDI, but clinical adverse consequences were rarely reported. Among three databases, interactions detected by Drugs.com® were greatest in number, whereas Lexicomp® provided the broadest list of medications. Development of such databases based on both theoretical and clinical conceptions should be focused to balance safety of patients and weariness of healthcare providers.
Citation: Pinkoh R, Rodsiri R, Wainipitapong S (2023) Retrospective cohort observation on psychotropic drug-drug interaction and identification utility from 3 databases: Drugs.com®, Lexicomp®, and Epocrates®. PLoS ONE 18(6): e0287575. https://doi.org/10.1371/journal.pone.0287575
Editor: Chi-Shin Wu, NHRI: National Health Research Institutes, TAIWAN
Received: February 14, 2023; Accepted: June 7, 2023; Published: June 22, 2023
Copyright: © 2023 Pinkoh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All files are available from the Harvard Dataverse: Wainipitapong, Sorawit, 2023, "Psychotropic DDIs and Identification Utilities from three databases", https://doi.org/10.7910/DVN/OV5CW8, Harvard Dataverse, V1.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0287575#abstract0
