Alsfouk Bshra A, Aljanadi Qamar M, Almutairi Mona M
Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Front Pharmacol. 2025 May 14;16:1590167. doi: 10.3389/fphar.2025.1590167. eCollection 2025.
Drug-drug interactions (DDIs) of antipsychotic medications are clinically significant as they can result in toxicity or treatment failure. This study aims to assess the potential drug-drug and drug-tobacco interactions associated with antipsychotic medications in an outpatient setting. Predictors of antipsychotic DDIs and the impact of potential DDIs on patients' clinical outcomes were also evaluated in this study.
A cross-sectional study was conducted on outpatients in King Fahad Medical City in Riyadh, Saudi Arabia between 25 October 2020, and 26 November 2020, who received antipsychotic medications. Data were collected using medical record review. Potential DDIs were assessed using electronic Lexicomp. The identified potential DDIs were categorized based on risk rating, severity, and reliability rating. Potential adverse effects from interactions were classified by mechanism into pharmacodynamic and pharmacokinetic.
The study included 220 patients who received 804 drug combinations (i.e., ≥2 drugs concomitantly administered) between antipsychotics and other concomitant drugs. The commonest concomitant classes were antidepressants (20%), anticonvulsants (18%) and cardiovascular agents (15%). The rate of potential DDIs was 71% (n = 574/804). Of the DDIs identified, 92% and 7% were rated C (require monitor therapy) and D (require modify regimen), respectively. In terms of severity level, the majority (n = 552, 96%) of interactions were considered moderate and only 9 interactions were categorized as major. The level of scientific evidence was classified as fair in 64% and as good in 36% of interactions. The majority (91%) involved pharmacodynamic interactions rather than pharmacokinetic mechanisms (9%). The most frequent potential adverse effects were increased sedation (36%), hyperglycemia (15%) and decreased blood pressure (14%). Receiving polypharmacy (i.e., ≥5 drugs concomitantly administered) was significantly associated with an increased probability of drug interaction occurrence (OR = 42, P = 0.0026). Uncontrolled disease state was slightly higher in patients with potential DDIs compared to those with no DDIs (24% vs. 22%, P = 1). Likewise, adverse drug effects were significantly more common in patients with potential DDIs (89% vs. 72%, P = 0.014). The rate of potential drug-tobacco interactions was 6% of patients.
Potential DDIs of antipsychotic drugs were frequent (71%) and were associated with increased adverse effects. It is crucial for the clinicians to be aware of DDIs, monitor patients closely, and make the appropriate interventions. This emphasizes the importance of enhancing the knowledge about DDIs and the use of reliable AI machines, such as clinical decision support systems, to prevent medication errors.
抗精神病药物的药物相互作用（DDIs）具有临床意义，因为它们可能导致毒性反应或治疗失败。本研究旨在评估门诊环境中与抗精神病药物相关的潜在药物相互作用和药物-烟草相互作用。本研究还评估了抗精神病药物DDIs的预测因素以及潜在DDIs对患者临床结局的影响。
于2020年10月25日至2020年11月26日在沙特阿拉伯利雅得法赫德国王医疗城对接受抗精神病药物治疗的门诊患者进行了一项横断面研究。通过病历审查收集数据。使用电子Lexicomp评估潜在的DDIs。根据风险评级、严重程度和可靠性评级对识别出的潜在DDIs进行分类。相互作用产生的潜在不良反应按机制分为药效学和药代动力学两类。
该研究纳入了220例患者，他们接受了抗精神病药物与其他同时使用药物之间的804种药物组合（即同时使用≥2种药物）。最常见的同时使用药物类别为抗抑郁药（20%）、抗惊厥药（18%）和心血管药物（15%）。潜在DDIs的发生率为71%（n = 574/804）。在识别出的DDIs中，92%和7%分别被评为C级（需要监测治疗）和D级（需要调整治疗方案）。就严重程度而言，大多数相互作用（n = 552，96%）被认为是中度的，只有9种相互作用被归类为重度。64%的相互作用的科学证据水平被分类为中等，36%为良好。大多数（91%）涉及药效学相互作用，而非药代动力学机制（9%）。最常见的潜在不良反应是镇静作用增强（36%）、高血糖（15%）和血压降低（14%）。接受联合用药（即同时使用≥5种药物）与药物相互作用发生概率增加显著相关（OR = 42，P = 0.0026）。与无潜在DDIs的患者相比，有潜在DDIs的患者未控制的疾病状态略高（24%对22%，P = 1）。同样，有潜在DDIs的患者药物不良反应明显更常见（89%对72%，P = 0.014）。潜在药物-烟草相互作用的发生率为患者的6%。
抗精神病药物的潜在DDIs很常见（71%），且与不良反应增加相关。临床医生必须意识到DDIs，密切监测患者并进行适当干预。这强调了增强对DDIs的认识以及使用可靠的人工智能机器（如临床决策支持系统）以预防用药错误的重要性。
