Risk Analysis of CYP450-mediated Drug Interaction in Medical Orders of Psychiatric Inpatients

OBJECTIVE To investigate the existence of cytochrome P450(CYP450)-mediated drug interactions in medical orders of psychiatric inpatients in the First Hospital of Hebei Medical University, analyze the potential drug interactions of clinical significance, and provide reference for clinical use of drugs. METHODS Statistical analysis of all operating medical orders of psychiatric inpatients from July 1 to December 31, 2018 in the First Hospital of Hebei Medical University was carried out, and ≥ 2 medical orders were used in combination to record the CYP450 enzyme substrates, inhibitors, or inducers were contained in the combined drug use. Based on the theory of metabolic enzymes and related drug instructions and literature, the potential metabolic drug interactions in medical orders were evaluated, and counted the cases of actual clinical drug interactions. RESULTS A total of 1 658 cases were examined, of which 227 were metabolic drug interactions, accounting for 13.7%. The subtypes involved in the CYP enzyme were mainly CYP2D6(n=176, 77.5%), CYP3A4(n=105, 46.3%), CYP2C19(n=24, 10.6%), and CYP2C9(n=5, 2.2%). Six cases of clinical drug interactions were occurred, accounting for 2.6%. CONCLUSION There are many potential metabolic drug interactions in the medical orders of psychiatric inpatients in the First Hospital of Hebei Medical University. In order to improve the efficacy and safety of treatment, it is necessary to avoid the combination of drugs with adverse interaction reported in the literature, and to select similar drugs that have no interaction or less interaction.