title: Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards.
abstract: OBJECTIVE
  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.
authors.affiliation: Academic Unit of Molecular and Clinical Pharmacology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
authors.forename: S J C
authors.initials: SJ
authors.lastname: Davies
authors.forename: S
authors.initials: S
authors.lastname: Eayrs
authors.forename: P
authors.initials: P
authors.lastname: Pratt
authors.forename: M S
authors.initials: MS
authors.lastname: Lennard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019389:Cytochrome P-450 CYP2D6; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System; D004338:Drug Combinations; D004347:Drug Interactions; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008485:Medical Audit; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged
chemical_list: D004338:Drug Combinations; D003577:Cytochrome P-450 Enzyme System; C104464:CYP3A protein, human; D019389:Cytochrome P-450 CYP2D6; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human