Incidence and Risk Factors of Drug-Drug Interactions in Psychiatric Wards of a Medical Center
| Autor: | Shiou-Huei Huang, 黃秀慧 |
|---|---|
| Rok vydání: | 2000 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 88 Polypharmacy has been popularly employed in disease treatment. The trend of multiple drug usage in the treatment of diseases has resulted in either beneficial or adverse effects. Therefore, drug interactions have been a focus of clinical service and research. The study was performed throughout a three-month period, using well-recognized drug interaction books and softwares to detect the potential drug interactions existed in medication profiles of the study population. The pharmacist would screen all new prescriptions, either newly admitted or changed medical orders during hospitalization, for drug interaction potentials in each patient’s therapeutic regimen. Subsequently, the pharmacist would provide respective physicians with information regarding potential drug interactions that may occur in their patients. Only drug interactions of either major or moderate degrees of severity would be reported. The medical teams of direct patient care would evaluate, as the first step, whether patients with medication profiles containing drug interaction pairs developed clinical responses caused by drug interactions during hospitalization. Furthermore, a second step of evaluating clinical significant drug interactions was carefully conducted by a committee consisted of a psychopharmacologist, a pharmacologist, and a pharmacist. The task of the evaluation committee was to determine ultimately if the clinical responses manifested by patients were indeed induced by drug interactions. During the study period, a total of 152 psychiatric inpatients were enrolled. One hundred and thirty drug interaction pairs were detected in 78 patients, thereby, the overall incidence of potential drug interactions in this study was 51.3%. The most frequently observed drug interaction pairs were haloperidol-anticholinergics (14.5%), phenothiazines-anticholinergics (13.8%), and SSRIs-trazodone (13.8%). The severity of detected potential drug interactions was mostly moderate, with an occurrence rate of 80.0%. The documented pharmacologicol effects of an interacting drug imposing on the object drug were mostly synergistic (56.9%). The majority of clinical responses elicited by drug interaction pairs was additive (73.1%). Nearly 95% of the potential interactions identified indicated merely a need for close patient monitoring. We also observed that the incidence of detected potential drug interactions decreased from 63.9% in the first month to 44.7% in the second month, demonstrating most likely a greater physicians’ alertness of potential drug interactions in medication profiles. There were 15 patients, with a total of 17 drug interaction pairs appeared in their medication profiles, developed clinical reactions that were documented by their respective physicians. Following vigilant assessment by the three-member committee, only two cases were evaluated as truly caused by drug interactions. Hence, the incidence of clinical significant drug interactions in the study was 1.3%. The interaction pairs that led to drug interactions of clinical significance were trazodone-chlorpromazine and doxepin-paroxetine, respectively. Ours study revealed a high incidence of potential drug interactions in the medication profiles of psychiatric inpatients as compared to previous studies. However, the incidence of clinical significant drug interactions was low, indicating preventive measures were appropriately applied at the institution of the study. Approximately a 20% reduction of the incidence of potential drug interactions in the second month from the first month suggests that pharmacists may play effective roles in improving physicians’ attentiveness of drug interactions through actively providing physicians with relevant drug information. It is also likely that pharmacists’ participation of direct patient care would be helpful in preventing undesired therapeutic outcomes and in optimizing drug therapy at the psychiatric wards in Taiwan in the future. |
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