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Multimorbidity and Polypharmacy in Psychosis: Identifying Potentially Significant Drug Interactions in an Old Age Inpatient Psychiatry Setting
Published online by Cambridge University Press: 07 July 2023
Abstract
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Aims
To determine potentially significant drug interactions in an old age setting among inpatients with psychosis and medical comorbidities over the past 12 months
Methods
Study setting: old age inpatient functional ward
Sample size: 11
Inclusion criteria:
• Inpatients on psychotropic medications with diagnosis ranging from F20 to F29 (ICD-10)
• Comorbid chronic medical condition(s) requiring long term drug treatment
Exclusion criteria:
• Patients with other/co-existing mental health diagnosis excluded
• Antibiotics , OTC medications, herbal treatments, emergency treatments and other medications requiring short-term administration excluded from analysis
Study tools:
• Lexicomp® interaction checker
◦ Category X: Avoid combination
◦ Category D: Consider therapy modification
◦ Further categories (In order of decreasing risk ratings: C, B, A) excluded from the analysis
Results
Out of the total 67 inpatients admitted between January 2022 and December 2022, 17 patients had diagnosis ranging between F20 and F29. 4 patients were excluded due to no medical comorbidities and 2 were excluded due to lack of data. Among the 11 patients included in the analysis, the most common medical comorbidities were, in decreasing order, hypertension, hypercholesterolemia and chronic pain. A total of 114 interactions were noted between psychotropic medications and other physical health medications, as follows:
No significant interactions: (category A, B, C): 103
Category D (consider therapy modification): 10
• 7 of these interactions were associated with administering Buprenorphine with other medications (Flupentixol, Gabapentin, Nortriptyline, Olanzapine, Amisulpride, Aripiprazole and Pregabalin) leading to additive CNS depressant effects.
• Interaction of codeine with Valproate and Flupentixol carried risk of CNS depression.
• Carbamazepine interacted with Risperidone via CYP enzyme induction.
Category X (avoid combination): 1
• The interaction between Flupentixol and Glycopyrronium was associated with risk of severe anticholinergic effects
Conclusion
This study is a preliminary investigation towards understanding the drug interactions in a population with long term mental health and physical health ailments. Awareness regarding the potential interactions can help avoid combinations with possible detrimental effects. The limitations of this study, in terms of sample size and quality of available data, can be overcome by conducting a planned study on a larger population.
Financial Sponsorship: none
Conflict of interests: none
- Type
- Psychopharmacology
- Information
- BJPsych Open , Volume 9 , Supplement S1: Abstracts from the RCPsych International Congress 2023, 10–13 July , July 2023 , pp. S192 - S193
- Creative Commons
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This does not need to be placed under each abstract, just each page is fine.- Copyright
- Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
Footnotes
Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication.
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