Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients
Introduction and Objectives: Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age >...
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doaj-0c0ba928a68d453783f0a9bba841fcd62021-01-08T04:11:16ZengWolters Kluwer Medknow PublicationsJournal of Family Medicine and Primary Care2249-48632020-01-019126023604010.4103/jfmpc.jfmpc_1060_20Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatientsBiswadeep DasSaravana Kumar RamasubbuBarun KumarVikram Singh RawatIntroduction and Objectives: Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients. Methods: This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions. Results: A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories. Conclusions: Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients.http://www.jfmpc.com/article.asp?issn=2249-4863;year=2020;volume=9;issue=12;spage=6023;epage=6040;aulast=Dasdrug-induced qt prolongationelderly patientspsychiatry opdpsychotropic drugstorsade de pointes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Biswadeep Das Saravana Kumar Ramasubbu Barun Kumar Vikram Singh Rawat |
spellingShingle |
Biswadeep Das Saravana Kumar Ramasubbu Barun Kumar Vikram Singh Rawat Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients Journal of Family Medicine and Primary Care drug-induced qt prolongation elderly patients psychiatry opd psychotropic drugs torsade de pointes |
author_facet |
Biswadeep Das Saravana Kumar Ramasubbu Barun Kumar Vikram Singh Rawat |
author_sort |
Biswadeep Das |
title |
Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients |
title_short |
Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients |
title_full |
Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients |
title_fullStr |
Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients |
title_full_unstemmed |
Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients |
title_sort |
top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to qt interval prolonging drug use in elderly psychiatry outpatients |
publisher |
Wolters Kluwer Medknow Publications |
series |
Journal of Family Medicine and Primary Care |
issn |
2249-4863 |
publishDate |
2020-01-01 |
description |
Introduction and Objectives: Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients. Methods: This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions. Results: A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories. Conclusions: Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients. |
topic |
drug-induced qt prolongation elderly patients psychiatry opd psychotropic drugs torsade de pointes |
url |
http://www.jfmpc.com/article.asp?issn=2249-4863;year=2020;volume=9;issue=12;spage=6023;epage=6040;aulast=Das |
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