Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards
Aims To assess the potential for interactions involving cytochromes P450 2D6 (CYP2D6) and 3A4 (CYP3A4) between drugs prescribed in a city in‐patient psychiatric service. Methods Prescription information was obtained from all 236 patients in general adult wards and all 87 patients in functional elder...
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| Veröffentlicht in: | British journal of clinical pharmacology 2004-04, Vol.57 (4), p.464-472 |
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| creator | Davies, S. J. C. Eayrs, S. Pratt, P. Lennard, M. S. |
| description | Aims
To assess the potential for interactions involving cytochromes P450 2D6 (CYP2D6) and 3A4 (CYP3A4) between drugs prescribed in a city in‐patient psychiatric service.
Methods
Prescription information was obtained from all 236 patients in general adult wards and all 87 patients in functional elderly wards under a city psychiatric service. The frequencies with which combinations of drugs expected to interact via CYP2D6 or CYP3A4 were documented and compared between these two settings.
Results
All 2089 drug prescriptions, of which 1237 (59%) were administered, were analyzed. One hundred and seventy‐two patients (73%) on adult wards and 59 (68%) on functional elderly wards were prescribed at least one drug metabolized by and/or inhibiting CYP2D6, the difference being nonsignificant (95% confidence interval on the difference −6.3%, 16.4%). Anticipated interactions from 62/82 CYP2D6‐related combinations prescribed on adult wards (27/100 patients) and 19/30 prescribed to elderly patients (22/100 patients) were judged to be clinically important or potentially clinically important. The proportion of patients on functional elderly wards prescribed at least one drug interacting with CYP3A4 (87%) was significantly greater than that for patients on adult wards (57%, P |
| doi_str_mv | 10.1111/j.1365-2125.2003.02040.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1884484</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>17978357</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5310-7dc44f3d169ce8f2fc55985f023796c89c2d9c875224ea76c7c4074322e034cb3</originalsourceid><addsrcrecordid>eNqNkc1uEzEUhS0EoqHwCsgb2M3g37FnAVIJv1IlsoC15Xo8iSPHDvZM2nkHHhpPEpV2hze2db977tE9AECMalzOu22NacMrggmvCUK0RgQxVN89AYv7wlOwQBQ1FSccX4AXOW8RwhQ3_Dm4wBwRLhhfgD-rONgwOO1hHxPs0riGLgw2aTO4GHL5HKI_uLCGZhqi2aS4sxmuGEeQfGqgDh2kVwzGANc2lDYPdTf6Ae7zZDZOD8mZI9SP4ahYAOs7m_z0CLnVqcsvwbNe-2xfne9L8OvL55_Lb9X1j6_fl1fXleEUo0p0hrGedrhpjZU96Q3nreQ9IlS0jZGtIV1rpOCEMKtFY4RhSDBKiEWUmRt6CT6cdPfjzc52piygGFf75HY6TSpqpx5XgtuodTwoLCVjkhWBt2eBFH-PNg9q57Kx3utg45gVFq2QlIsCyhNoUsw52f5-CEZqjlJt1ZyYmhNTc5TqGKW6K62vH5r813jOrgBvzoDORvs-6WBcfsBx2ZQdFO79ibt13k7_bUB9XK7mF_0LAi-8OQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>17978357</pqid></control><display><type>article</type><title>Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards</title><source>MEDLINE</source><source>Wiley Online Library Free Content</source><source>Access via Wiley Online Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Davies, S. J. C. ; Eayrs, S. ; Pratt, P. ; Lennard, M. S.</creator><creatorcontrib>Davies, S. J. C. ; Eayrs, S. ; Pratt, P. ; Lennard, M. S.</creatorcontrib><description>Aims
To assess the potential for interactions involving cytochromes P450 2D6 (CYP2D6) and 3A4 (CYP3A4) between drugs prescribed in a city in‐patient psychiatric service.
Methods
Prescription information was obtained from all 236 patients in general adult wards and all 87 patients in functional elderly wards under a city psychiatric service. The frequencies with which combinations of drugs expected to interact via CYP2D6 or CYP3A4 were documented and compared between these two settings.
Results
All 2089 drug prescriptions, of which 1237 (59%) were administered, were analyzed. One hundred and seventy‐two patients (73%) on adult wards and 59 (68%) on functional elderly wards were prescribed at least one drug metabolized by and/or inhibiting CYP2D6, the difference being nonsignificant (95% confidence interval on the difference −6.3%, 16.4%). Anticipated interactions from 62/82 CYP2D6‐related combinations prescribed on adult wards (27/100 patients) and 19/30 prescribed to elderly patients (22/100 patients) were judged to be clinically important or potentially clinically important. The proportion of patients on functional elderly wards prescribed at least one drug interacting with CYP3A4 (87%) was significantly greater than that for patients on adult wards (57%, P < 0.001). The frequency of interactions involving CYP3A4 was significantly greater on functional elderly than adult wards (43/100 vs 22/100 patients, P < 0.025, 95% confidence interval on the difference 4, 38/100).
Conclusions
Our findings confirm extensive polypharmacy on general adult psychiatric and functional elderly psychiatric wards. A substantial proportion of patients were receiving combinations of drugs that interact with CYP2D6 and/or CYP3A4, many of which are known to produce clinically important interactions. Doctors practising in old age psychiatry should be aware that patients on functional elderly wards are at increased risk of clinically important CYP3A4 interactions. Psychiatrists should consider the pharmacokinetic implications of drugs prescribed for use ‘as needed’, because of the potential for unpredictable interactions.</description><identifier>ISSN: 0306-5251</identifier><identifier>EISSN: 1365-2125</identifier><identifier>DOI: 10.1111/j.1365-2125.2003.02040.x</identifier><identifier>PMID: 15025745</identifier><identifier>CODEN: BCPHBM</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; CYP2D6 ; CYP3A4 ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 CYP3A ; Cytochrome P-450 Enzyme System ; Drug Combinations ; Drug Interactions ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Medical Audit ; Medical sciences ; Mental Disorders - drug therapy ; Middle Aged ; Neuropharmacology ; Pharmacology. Drug treatments ; Psycholeptics: tranquillizer, neuroleptic ; Psychology. Psychoanalysis. Psychiatry ; Psychopharmacology ; psychotropic drugs</subject><ispartof>British journal of clinical pharmacology, 2004-04, Vol.57 (4), p.464-472</ispartof><rights>2005 INIST-CNRS</rights><rights>2004 Blackwell Publishing Ltd 2004</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5310-7dc44f3d169ce8f2fc55985f023796c89c2d9c875224ea76c7c4074322e034cb3</citedby><cites>FETCH-LOGICAL-c5310-7dc44f3d169ce8f2fc55985f023796c89c2d9c875224ea76c7c4074322e034cb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2125.2003.02040.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2125.2003.02040.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15586752$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15025745$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Davies, S. J. C.</creatorcontrib><creatorcontrib>Eayrs, S.</creatorcontrib><creatorcontrib>Pratt, P.</creatorcontrib><creatorcontrib>Lennard, M. S.</creatorcontrib><title>Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards</title><title>British journal of clinical pharmacology</title><addtitle>Br J Clin Pharmacol</addtitle><description>Aims
To assess the potential for interactions involving cytochromes P450 2D6 (CYP2D6) and 3A4 (CYP3A4) between drugs prescribed in a city in‐patient psychiatric service.
Methods
Prescription information was obtained from all 236 patients in general adult wards and all 87 patients in functional elderly wards under a city psychiatric service. The frequencies with which combinations of drugs expected to interact via CYP2D6 or CYP3A4 were documented and compared between these two settings.
Results
All 2089 drug prescriptions, of which 1237 (59%) were administered, were analyzed. One hundred and seventy‐two patients (73%) on adult wards and 59 (68%) on functional elderly wards were prescribed at least one drug metabolized by and/or inhibiting CYP2D6, the difference being nonsignificant (95% confidence interval on the difference −6.3%, 16.4%). Anticipated interactions from 62/82 CYP2D6‐related combinations prescribed on adult wards (27/100 patients) and 19/30 prescribed to elderly patients (22/100 patients) were judged to be clinically important or potentially clinically important. The proportion of patients on functional elderly wards prescribed at least one drug interacting with CYP3A4 (87%) was significantly greater than that for patients on adult wards (57%, P < 0.001). The frequency of interactions involving CYP3A4 was significantly greater on functional elderly than adult wards (43/100 vs 22/100 patients, P < 0.025, 95% confidence interval on the difference 4, 38/100).
Conclusions
Our findings confirm extensive polypharmacy on general adult psychiatric and functional elderly psychiatric wards. A substantial proportion of patients were receiving combinations of drugs that interact with CYP2D6 and/or CYP3A4, many of which are known to produce clinically important interactions. Doctors practising in old age psychiatry should be aware that patients on functional elderly wards are at increased risk of clinically important CYP3A4 interactions. Psychiatrists should consider the pharmacokinetic implications of drugs prescribed for use ‘as needed’, because of the potential for unpredictable interactions.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>CYP2D6</subject><subject>CYP3A4</subject><subject>Cytochrome P-450 CYP2D6</subject><subject>Cytochrome P-450 CYP3A</subject><subject>Cytochrome P-450 Enzyme System</subject><subject>Drug Combinations</subject><subject>Drug Interactions</subject><subject>Hospitalization</subject><subject>Hospitals, Psychiatric</subject><subject>Humans</subject><subject>Medical Audit</subject><subject>Medical sciences</subject><subject>Mental Disorders - drug therapy</subject><subject>Middle Aged</subject><subject>Neuropharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Psycholeptics: tranquillizer, neuroleptic</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopharmacology</subject><subject>psychotropic drugs</subject><issn>0306-5251</issn><issn>1365-2125</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1uEzEUhS0EoqHwCsgb2M3g37FnAVIJv1IlsoC15Xo8iSPHDvZM2nkHHhpPEpV2hze2db977tE9AECMalzOu22NacMrggmvCUK0RgQxVN89AYv7wlOwQBQ1FSccX4AXOW8RwhQ3_Dm4wBwRLhhfgD-rONgwOO1hHxPs0riGLgw2aTO4GHL5HKI_uLCGZhqi2aS4sxmuGEeQfGqgDh2kVwzGANc2lDYPdTf6Ae7zZDZOD8mZI9SP4ahYAOs7m_z0CLnVqcsvwbNe-2xfne9L8OvL55_Lb9X1j6_fl1fXleEUo0p0hrGedrhpjZU96Q3nreQ9IlS0jZGtIV1rpOCEMKtFY4RhSDBKiEWUmRt6CT6cdPfjzc52piygGFf75HY6TSpqpx5XgtuodTwoLCVjkhWBt2eBFH-PNg9q57Kx3utg45gVFq2QlIsCyhNoUsw52f5-CEZqjlJt1ZyYmhNTc5TqGKW6K62vH5r813jOrgBvzoDORvs-6WBcfsBx2ZQdFO79ibt13k7_bUB9XK7mF_0LAi-8OQ</recordid><startdate>200404</startdate><enddate>200404</enddate><creator>Davies, S. J. C.</creator><creator>Eayrs, S.</creator><creator>Pratt, P.</creator><creator>Lennard, M. S.</creator><general>Blackwell Science Ltd</general><general>Blackwell Science</general><general>Blackwell Science Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7U2</scope><scope>7U7</scope><scope>C1K</scope><scope>5PM</scope></search><sort><creationdate>200404</creationdate><title>Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards</title><author>Davies, S. J. C. ; Eayrs, S. ; Pratt, P. ; Lennard, M. S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5310-7dc44f3d169ce8f2fc55985f023796c89c2d9c875224ea76c7c4074322e034cb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>CYP2D6</topic><topic>CYP3A4</topic><topic>Cytochrome P-450 CYP2D6</topic><topic>Cytochrome P-450 CYP3A</topic><topic>Cytochrome P-450 Enzyme System</topic><topic>Drug Combinations</topic><topic>Drug Interactions</topic><topic>Hospitalization</topic><topic>Hospitals, Psychiatric</topic><topic>Humans</topic><topic>Medical Audit</topic><topic>Medical sciences</topic><topic>Mental Disorders - drug therapy</topic><topic>Middle Aged</topic><topic>Neuropharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Psycholeptics: tranquillizer, neuroleptic</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopharmacology</topic><topic>psychotropic drugs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Davies, S. J. C.</creatorcontrib><creatorcontrib>Eayrs, S.</creatorcontrib><creatorcontrib>Pratt, P.</creatorcontrib><creatorcontrib>Lennard, M. S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Safety Science and Risk</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of clinical pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Davies, S. J. C.</au><au>Eayrs, S.</au><au>Pratt, P.</au><au>Lennard, M. S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards</atitle><jtitle>British journal of clinical pharmacology</jtitle><addtitle>Br J Clin Pharmacol</addtitle><date>2004-04</date><risdate>2004</risdate><volume>57</volume><issue>4</issue><spage>464</spage><epage>472</epage><pages>464-472</pages><issn>0306-5251</issn><eissn>1365-2125</eissn><coden>BCPHBM</coden><abstract>Aims
To assess the potential for interactions involving cytochromes P450 2D6 (CYP2D6) and 3A4 (CYP3A4) between drugs prescribed in a city in‐patient psychiatric service.
Methods
Prescription information was obtained from all 236 patients in general adult wards and all 87 patients in functional elderly wards under a city psychiatric service. The frequencies with which combinations of drugs expected to interact via CYP2D6 or CYP3A4 were documented and compared between these two settings.
Results
All 2089 drug prescriptions, of which 1237 (59%) were administered, were analyzed. One hundred and seventy‐two patients (73%) on adult wards and 59 (68%) on functional elderly wards were prescribed at least one drug metabolized by and/or inhibiting CYP2D6, the difference being nonsignificant (95% confidence interval on the difference −6.3%, 16.4%). Anticipated interactions from 62/82 CYP2D6‐related combinations prescribed on adult wards (27/100 patients) and 19/30 prescribed to elderly patients (22/100 patients) were judged to be clinically important or potentially clinically important. The proportion of patients on functional elderly wards prescribed at least one drug interacting with CYP3A4 (87%) was significantly greater than that for patients on adult wards (57%, P < 0.001). The frequency of interactions involving CYP3A4 was significantly greater on functional elderly than adult wards (43/100 vs 22/100 patients, P < 0.025, 95% confidence interval on the difference 4, 38/100).
Conclusions
Our findings confirm extensive polypharmacy on general adult psychiatric and functional elderly psychiatric wards. A substantial proportion of patients were receiving combinations of drugs that interact with CYP2D6 and/or CYP3A4, many of which are known to produce clinically important interactions. Doctors practising in old age psychiatry should be aware that patients on functional elderly wards are at increased risk of clinically important CYP3A4 interactions. Psychiatrists should consider the pharmacokinetic implications of drugs prescribed for use ‘as needed’, because of the potential for unpredictable interactions.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>15025745</pmid><doi>10.1111/j.1365-2125.2003.02040.x</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Biological and medical sciences CYP2D6 CYP3A4 Cytochrome P-450 CYP2D6 Cytochrome P-450 CYP3A Cytochrome P-450 Enzyme System Drug Combinations Drug Interactions Hospitalization Hospitals, Psychiatric Humans Medical Audit Medical sciences Mental Disorders - drug therapy Middle Aged Neuropharmacology Pharmacology. Drug treatments Psycholeptics: tranquillizer, neuroleptic Psychology. Psychoanalysis. Psychiatry Psychopharmacology psychotropic drugs |
| title | Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards |
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