Drug–drug interactions in general hospital and psychiatric hospital in-patients prescribed psychotropic medications

Abstract

Objectives. Drug–drug interactions (DDIs) present a serious, ever increasing clinical problem. Previous studies identified DDIs among psychiatric inpatients prescribed psychotropics, but none have focused on psychotropics prescribed to General Hospital inpatients. This study aimed to identify: putative drug–drug interactions; mechanisms; potential seriousness among patients prescribed psychotropes in both psychiatric and general hospital inpatients settings. We hypothesised that potential interactions per person would be greater in General Hospital inpatients on psychotropics, due to polypharmacy. Method. We surveyed psychotropic prescribing in hospital wards in a public sector mental health organisation and a 500-bed general hospital. Ward pharmacists collected drug prescription data. A computer based protocol evaluated DDIs. Results. A total of 7.4% of General Hospital inpatients and 100% of Psychiatric Unit inpatients surveyed were prescribed psychotropic medication. The General Hospital group had significantly more potential interactions per person (3.0) than Psychiatric inpatients (1.3) (P<0.05). There were significantly more potentially serious interactions in the general hospital group (P<0.025). Conclusions. DDIs affect those prescribed psychotropics in both General and Psychiatric Hospitals. The General Hospital patients had a higher number per person and more serious potential interactions, yet are often poorly served by psychiatric services, suggesting that liaison psychiatrists have a role in physician education and DDI assessment.

Key Words::

• Drug interactions
• psychotropic drugs
• psychiatry
• inpatients

Acknowledgements

We gratefully acknowledge the assistance provided by the pharmacy staff of the Bristol Royal Infirmary and the Avon & Wiltshire Mental Health Partnership NHS Trust.

Statement of interest

There are no direct conflicts of interest and this work was not commissioned nor funded by any external agency. Drs Sinclair and Potokar have no conflicts of interest to disclose. Mr Parton has been on an advisory board for AstraZeneca and was funded to attend a conference by Lilly. He has also been on advisory boards for Janssen-Cilag, Lilly, Servier and Lundbeck and has received funding as a conference delegate. Dr Davies has performed speaking engagements unconnected to this study for two pharmaceutical companies with fees being paid to the University of Bristol.