Psychiatric Hospital Idrija, 5280 Idrija, Slovenia.
Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia.
Medicina (Kaunas). 2023 Feb 1;59(2):284. doi: 10.3390/medicina59020284.
: Patients with schizophrenia are often exposed to polypharmacotherapy, which may lead to drug-drug interactions. The aim of the study was to investigate the prevalence of potential drug-drug interactions (pDDIs) in hospitalized patients with schizophrenia spectrum disorders and to identify factors associated with pDDIs and manifested symptoms and signs. : This cross-sectional observational study included 311 inpatients admitted to a psychiatric hospital. The LexiComp drug interaction program was used to identify pDDIs in 2014. Factors associated with the prevalence of pDDIs and factors related to clinically observed symptoms and signs were assessed using multivariable regression. In addition, replicate analysis of pDDI was performed using 2021 program updates. The prevalence of pDDIs was 88.7%. Our study showed that more than half of the patients received at least one drug combination that should be avoided. The most common pDDIs involved combinations of two antipsychotics or combinations of antipsychotics and benzodiazepines, which can lead to cardio-respiratory depression, sedation, arrhythmias, anticholinergic effects, and neuroleptic malignant syndrome. The number of prescribed drugs was a risk factor for pDDIs (OR 2.85; 95% CI 1.84-5.73). All groups of clinically observed symptoms and signs were associated with the number of drugs. In addition, symptoms and signs characteristic of the nervous system and psychiatric disorders were associated with antipsychotic dosage (IRR 1.33; 95% CI 1.12-1.58), which could contribute to the development of extrapyramidal syndrome, insomnia, anxiety, agitation, and bipolar mania. The 2021 version of the drug interaction program showed a shift in drug interactions toward a lower risk rating, implying less severe patient management and possibly less alert fatigue. Patients with schizophrenia spectrum disorders are at high risk of developing drug-drug interactions. Optimization of drug therapy, patient monitoring, and use of drug interaction programs could help to prevent pDDIs and subsequent adverse drug events.
：精神分裂症患者常接受多药物治疗，这可能导致药物-药物相互作用。本研究旨在调查住院精神分裂症谱系障碍患者中潜在药物-药物相互作用（pDDI）的发生率，并确定与 pDDI 及临床表现相关的因素。：本横断面观察性研究纳入了 311 名入住精神病院的住院患者。2014 年使用 LexiComp 药物相互作用程序来识别 pDDI。使用多变量回归评估与 pDDI 发生率相关的因素以及与临床观察到的症状和体征相关的因素。此外，使用 2021 年程序更新进行了 pDDI 的重复分析。pDDI 的发生率为 88.7%。我们的研究表明，超过一半的患者接受了至少一种应避免的药物联合治疗。最常见的 pDDI 涉及两种抗精神病药物或抗精神病药物与苯二氮䓬类药物的联合用药，可能导致心肺抑制、镇静、心律失常、抗胆碱能作用和恶性神经阻滞剂综合征。开具的药物数量是 pDDI 的危险因素（OR 2.85；95%CI 1.84-5.73）。所有组的临床观察到的症状和体征都与药物数量有关。此外，神经系统和精神障碍的症状和体征与抗精神病药物剂量有关（IRR 1.33；95%CI 1.12-1.58），这可能导致锥体外系综合征、失眠、焦虑、激越和双相躁狂。药物相互作用程序的 2021 年版本显示药物相互作用的风险评级降低，这意味着患者管理的严重程度降低，可能疲劳程度降低。精神分裂症谱系障碍患者发生药物-药物相互作用的风险很高。优化药物治疗、患者监测和使用药物相互作用程序有助于预防 pDDI 及随后的药物不良事件。
