Evaluation of Drug Interactions with Psychotropic Drugs Causing QTc Prolongation – A Study in Palliative Care Patients

Authors : Fedain Abishov, Özgenur Geridönmez, Yahya Sekin, Kamer Tecen-Yucel

Pages : 655-670

Doi:10.55262/fabadeczacilik.1791969

View : 52 | Download : 101

Publication Date : 2025-10-30

Article Type : Research Paper

Abstract :The use of multiple QTc-prolonging psychotropic drugs or agents affecting their metabolism can lead to significant drug-drug interactions (DDIs). This study aims to compare the severity ratings of potential DDIs (pDDIs) specified in two interaction databases and identify clinically relevant interactions associated with QTc prolongation in palliative care patients. This prospective study was conducted in a palliative care unit of a state hospital between October 2023 and May 2024. Potential DDIs and their severities were assessed according to Micromedex® and Lexicomp® databases. Electrocardiograms (ECGs) were performed the patients flagged as having the risk of QTc prolongation. The Drug Interaction Probability Scale (DIPS) was applied to evaluate the clinical relevance of the detected interactions. A clinical pharmacist provided recommendations based on DIPS assessments. A total of 209 pDDIs involving 77 different drug pairs were identified among 120 patients. Interrater reliability between the two databases was poor for major pDDIs (kappa = –0.034) and overall (kappa = –0.052). A pDDI involving a psychotropic drug was detected in 61.7% of patients. QTc prolongation was observed in 66.7% of patients who underwent ECG (n=58). According to DIPS, 122 clinically relevant DDIs (63 unique pairs) were identified. Physicians accepted 10.5% of the clinical pharmacist’s recommendations, leading to modifications in psychotropic drug regimens. Follow-up ECGs revealed no QTc prolongation after the interventions. The findings highlight the frequent exposure of palliative care patients to psychotropic drug interactions that may prolong QTc. Although drug interaction databases provide guidance, discrepancies in severity ratings and clinical relevance necessitate individualized patient evaluation by a multidisciplinary team, including clinical pharmacists, to ensure medication safety.
Keywords : psikotrop ilaçlar, ilaç etkileşimi programları, klinik olarak önemli ilaç etkileşimleri, palyatif bakım hastaları

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