Navigation

Psychotropic Drug List

Since 1990, General Hospital Psychiatry has published a supplement in which world experts offer selected citations in the most common problem areas encountered in the interface between medicine and psychiatry. Although these supplements are directed at the consultation-liaison psychiatrist, this supplement is applicable for the primary care physician interested in medical and psychotropic drug interactions. If treatment involves use of pharmacotherapeutic agents, clinical decision-making should include current knowledge of drug interactions. Strain and associates reviewed the literature regarding 53 commonly prescribed psychotropic medications, with an emphasis on drug-end organ dysfunction and drug-age interactions.

A MEDLINE database search of the past five years was conducted, and each drug was individually reviewed. The following factors affected whether an article was selected for review: age of citation, journal reliability/recognition, journal access, timeliness and article type. Eighty-three articles were selected. Trained pharmacists were asked to extract critical interaction data from available sources. Significance of drug interactions was rated as major, moderate or minor. The panel recommended that data derived directly from pharmaceutical companies not be totally abandoned as a source of accurate information. Data on adverse events secondary to drug interactions or errors in dosing are available on request from individual companies.

The data are presented as individual drug interaction scenarios in which the authors describe the mechanism of interaction of two drugs. In the instance of barbiturates and estrogen, for example, barbiturates are enzyme inducers and may increase the metabolism of estrogen. Once the interaction has occurred and the effects of the agent have become evident or dissipated, there is little need to alter therapy. If a patient taking a barbiturate begins post menopausal replacement therapy, determination of the appropriate estrogen dose should be guided by clinical response. However, if an oral contraceptive agent is used by a patient who is taking barbiturates, the barbiturate may increase the metabolism of the estrogen and lead to decreased efficacy of the contraceptive agent and allow ovulation to occur.

Following each report, the authors recommend an action. In this example, higher doses of estrogen may be required or alternative forms of contraception should be considered when using a barbiturate and estrogen therapy.

Following the drug interaction information, a list of contributors is provided. Each contributor has included an extensive list of references pertaining to specific areas. If specific clinical policy guidelines have been developed, a citation is also included.

Strain JJ, et al. Part II: Drug-psychotropic drug interactions and end organ dysfunction: clinical management recommendations, selected bibliography, and updating strategies. Gen Hosp Psych 1996;18:300 13.

EDITOR'S NOTE: The authors of this series present the practicing clinician with easily accessible data to formulate psychotherapeutic drug therapy for patients. It is a valuable addition to the clinician's library, and if the journal cannot be obtained from library sources, the publication can be obtained from Elsevier Science Publishing Co.--BARBARA APGAR, M.D., M.S.

COPYRIGHT 1997 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group