Evaluation of prescriptions and potential drug-drug interactions of psychotropic drugs in the outpatient department of psychiatry, in a tertiary care teaching hospital of South Odisha: A cross-sectional study

Abstract

Background: - Over the past three decades, the number of patients diagnosed with psychiatric disorders has shown a rising trend. In two decades, the global number of Disability Adjusted Life Years (DALYs) due to psychiatric conditions showed a sharp rise from 80.8 million to 125.3 million. The rapidly expanding field of psychopharmacology is challenging the traditional concepts of treatment and constantly seeking new drugs to treat psychiatric disorders. Patients receiving the drugs undergo complex regimens, which leads to drug-drug interaction [DDI]. Evidence in support of polypharmacy being beneficial is slim; rather, there is glowering and growing evidence with increased adverse effects.
Objective:
• To categorise potential DDI using Lexicomp®
• To determine the association of potential drug-drug interaction of psychotropic drugs with psychotropic polypharmacy
• To evaluate types of psychotropic polypharmacy
Material and Method: A cross-sectional study was conducted in the Department of Pharmacology in collaboration with the
Department of Psychiatry, MKCG Medical College and Hospital, Odisha. Six hundred and six prescriptions were analysed. Data collected from prescriptions was compiled using standard spreadsheet software MS Excel and analysed using SPSS version 22.0. Lexicomp® was used as a vital study tool for the categorisation of potential DDI. A p-value of <0.05 was considered statistically significant.
Result: Schizophrenia (n=163) was found to be the most common diagnosis. Benzodiazepine (n=520) was commonly prescribed with atypical antipsychotics (n=463). Potential DDI was observed between clozapine with clonazepam and valproate with lorazepam with a severity rating of major. Frequent prescription of trihexyphenidyl (THP) leads to adjunctive polypharmacy. There was a significant association found between potential DDI and psychotropic polypharmacy (p=0.007).
Conclusion: The prescribing of psychotropic medications and psychotropic polypharmacy has risen. Potential DDI identification, mitigation, and reduction of toxicity in patients have become a challenge. It reinforces the need for all stakeholders to participate in continuing education, utilizing tools and formularies for evidence-based and judicious prescribing. Adjuvant Polypharmacy with drugs like THP along with antipsychotics warrants further studies and, if possible, reduction and alteration. If polypharmacy cannot be averted, then switching over to rational polypharmacy is the call of the times.