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Prescribing safely in elderly psychiatric wards: survey of possible drug interactions

  • Akshya Vasudev (a1) and Richard Harrison (a2)
Abstract
Aims and Method

A cross-sectional survey of patient drug prescriptions on two elderly psychiatric wards was carried out to estimate the potential of drug–drug interactions. Two standardised databases, British National Formulary (BNF; British Medical Association & Royal Pharmaceutical Society of Great Britain, 2007) and Upto Date (www.uptodate.com/), were employed.

Results

A majority (96%) of drug prescriptions in our study could potentially cause drug–drug interactions. Most patients were on multiple drugs (on average eight drugs per patient). There was poor concordance between the two databases: BNF picked up fewer cases of potential drug–drug interactions than Upto Date (43 v. 152 instances) and they also estimated the potential for hazardousness differently.

Clinical Implications

Polypharmacy is common in elderly psychiatric patients and this increases the possibility of a drug–drug interaction. Estimating the risk of interactions depends on a sound knowledge in therapeutics and/or referring to a standardised source of information. the results of this study question the concordance of two well-referenced databases.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Bjorkman, I. K., Fastbom, J., Schmidt, I.K., et al (2002). Drug–drug interactions in the elderly. Annals of Pharmacotherapy, 36, 16751681.
British Medical Association & Royal Pharmaceutical Society of Great Britain (2007) British National Formulary (September issue). BMJ Books & Pharmaceutical Press.
Davies, S. J. C., Eayrs, S., Pratt, P., et al (2004) Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards. British Journal of Clinical Pharmacology, 57, 464472.
Edwards, S. & Kumar, V. A. (1984) A survey of prescribing of psychotropic drugs in a Birmingham psychiatric hospital. British Journal of Psychiatry, 145, 502507.
Katona, C. L. E. (2001) Psychotropics and drug interactions in the elderly patient. International Journal of Geriatric Psychiatry, 16 (suppl.), S86S90.
Office for National Statistics (2001) Census 2001 (http://www.statistics.gov.uk/census2001/pop2001/gateshead.asp).
Rittmannsberger, H., Meise, U., Schauflinger, K., et al (1999) Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics. European Psychiatry, 14, 3340.
Routledge, P. A., O'MAHONY, M. S. & Woodhouse, K.W. (2004) Adverse drug reactions in elderly patients. British Journal of Clinical Pharmacology, 57, 121126.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Prescribing safely in elderly psychiatric wards: survey of possible drug interactions

  • Akshya Vasudev (a1) and Richard Harrison (a2)
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