Evaluation of Psychotropic Drug Interactions and Inappropriate Use in Older Adults: A Cross-sectional Study

INTRODUCTION: Polypharmacy is common in older patients, and psychotropic medications prescribed to treat psychiatric disorders are an important cause of it. This study aimed to find out the potential drug–drug interactions that can happen when older outpatients take psychotropic medications along with other medications and to assess the changes in the anticholinergic burden (ACB) score.
METHODS: This cross-sectional study was conducted in a community pharmacy between January 30 and March 30, 2024. Older patients who visited the pharmacy between these dates, had at least one psychotropic medication in their prescription, and had been using at least one medication for the last month were included in this study. The Lexicomp® database was used to determine the interactions of psychotropics, the 2023 Beers Criteria® were used to evaluate medication suitability, and the ACB Calculator® was used for the ACB score.
RESULTS: The sample received 278 psychotropic medications on 211 prescriptions, and the most commonly prescribed was escitalopram. A total of 815 medication interactions were detected, 10 of which were at the X level and 88 at the D level. When psychotropics prescribed to older adults were evaluated according to the 2023 Beers criteria®, 16 different psychotropics prescribed were found to be potentially inappropriate according to 166 criteria. The ACB scores of the patients increased significantly after a psychotropic medication prescription (p<0.001).
DISCUSSION AND CONCLUSION: Given the high frequency of interactions and the increased ACB caused by psychotropic medications, it is important to evaluate their prescription for older patients with geriatric criteria. The results of the present study led us to suggest that all physicians should consider other medications and geriatric criteria when prescribing psychotropic medication to older patients.

Keywords: Anticholinergic burden score, Beers criteria®, Drug interactions, Older patients, Psychotropic medication