Clinical significance of potential drug–drug interactions in older adults with psychiatric disorders: a retrospective study

Abstract

Background Polypharmacy increases the risk of potential drug–drug interactions (pDDIs). This retrospective analysis was conducted to detect pDDIs and adverse drug reactions (ADRs) among older adults with psychiatric disorder, and identify pDDIs with clinical significance. Methods A retrospective analysis was carried out based on the medical records of older adults with psychiatric disorders. Data on demographic characteristics, substance abuse, medical history, and medications were extracted. The Lexi-Interact online database was used to detect pDDIs. The minimal clinically important difference (MCID) was set as the change in the Treatment Emergent Symptom Scale (TESS) score between admission and discharge. The median and interquartile ranges were used for continuous variables, and frequencies were calculated for dichotomous variables. Poisson regression was implemented to determine the factors influencing the number of ADR types. The influencing factors of each ADR and the clinical significance of the severity of the ADR were analysed using binary logistic regression. P < 0.05 was considered statistically significant. Results A total of 308 older adults were enrolled, 171 (55.52%) of whom had at least 1 pDDI. Thirty-six types of pDDIs that should be avoided were found, and the most frequent pDDI was the coadministration of lorazepam and olanzapine (55.5%). A total of 26 ADRs induced by pDDIs were identified, and the most common ADR was constipation (26.05%). There was a 9.4 and 10.3% increase in the number of ADR types for each extra medical diagnosis and for each extra drug, respectively. There was a 120% increase in the number of ADR types for older adults hospitalized for 18–28 days compared with those hospitalized for 3–17 days. There was an 11.1% decrease in the number of ADR types for each extra readmission. The length of hospitalization was a risk factor for abnormal liver function (P < 0.05). The use of a large number of drugs was a risk factor for gastric distress (P < 0.05) and dizziness and fainting (P < 0.05). None of the four pDDIs, including coadministrations of olanzapine and lorazepam, quetiapine and potassium chloride, quetiapine and escitalopram, and olanzapine and clonazepam, showed clinical significance of ADR severity (P > 0.05). Conclusions pDDIs are prevalent in older adults, and the rate is increasing. However, many pDDIs may have no clinical significance in terms of ADR severity. Further research on assessing pDDIs, and possible measures to prevent serious ADRs induced by DDIs is needed to reduce the clinical significance of pDDIs.

Mental Health Polypharmacy in “Non-Coded” Primary Care Patients: The Effect of Deprescribing

“…Both the patients and the clinicians reported a better understanding and management of mental health medications, validating the effectiveness of the strategies employed. Furthermore, the long-term feasibility and sustainability of these changes were confirmed, highlighting the potential for these practices to be integrated into routine clinical care [19,20].…”

Are polypharmacy side effects predicted by public data still valid in real-world data?

“…In previous studies, the difference between the predicted drug-drug-side effect relationship and the prevalence of side effects occurring in actual patients' clinical data was analyzed through prospective studies [26] , [27] . While some researchers have performed retrospective cohort studies on potential drug-drug interactions, most of these studies have only confirmed the prevalence of side effects occurring in cohorts of interest [28] , [29] , [30] . In this study, we conducted an exploratory retrospective investigation without specifying a particular cohort to evaluate the potential of real-world patient data in identifying adverse events for unknown drug-drug interactions.…”

Screening indicators to evaluate the clinical significance of drug-drug interactions in polypharmacy among older adults with psychiatric disorders: a delphi study

“…DDIs are frequent in polypharmacy [ 12 ], but many of them have just modest or no clinical significance [ 13 , 14 ]. Wolff [ 15 ] reported that the risk of potential DDIs in older adults increased significantly with the number of additional drugs or the severity of diseases, and that patients with recurrent or severe depression were more likely to receive a combination of multiple antidepressant drugs.…”