Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021

Ambrocio Teodoro Esteves Pairazaman; Emma Caldas Herrera; Gabriel Leon Apac; Jesús Daniel Collanque Pinto; María Evelina Caldas Herrera; Daniel Ñañez del Pino; Javier Francisco Martínez Carreras; Ricardo Robles Huaranca

doi:10.12688/f1000research.121692.1

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Research Article

Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021

[version 1; peer review: 1 not approved]

Ambrocio Teodoro Esteves Pairazaman ¹, Emma Caldas Herrera¹, Gabriel Leon Apac¹, [...] Jesús Daniel Collanque Pinto¹, María Evelina Caldas Herrera¹, Daniel Ñañez del Pino¹, Javier Francisco Martínez Carreras¹, Ricardo Robles Huaranca¹

Ambrocio Teodoro Esteves Pairazaman ¹, Emma Caldas Herrera¹, [...] Gabriel Leon Apac¹, Jesús Daniel Collanque Pinto¹, María Evelina Caldas Herrera¹, Daniel Ñañez del Pino¹, Javier Francisco Martínez Carreras¹, Ricardo Robles Huaranca¹

PUBLISHED 15 Jun 2022

Author details Author details

¹ Facultad de Farmacia y Bioquímica, Universidad Privada Norbert Wiener, Lima, Lima, 15072, Peru

Ambrocio Teodoro Esteves Pairazaman
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Supervision

Emma Caldas Herrera
Roles: Methodology, Supervision

Gabriel Leon Apac
Roles: Data Curation, Writing – Review & Editing

Jesús Daniel Collanque Pinto
Roles: Writing – Review & Editing

María Evelina Caldas Herrera
Roles: Writing – Review & Editing

Daniel Ñañez del Pino
Roles: Writing – Review & Editing

Javier Francisco Martínez Carreras
Roles: Writing – Original Draft Preparation

Ricardo Robles Huaranca
Roles: Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Emerging Diseases and Outbreaks gateway.

This article is included in the Coronavirus (COVID-19) collection.

Abstract

Background: Actual and potential drug–drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital during the months of February to July, 2021.
Methods: The study is deductive, retroprospective, quantitative, applied, cross-sectional observational. The instrument used was a collection card for 86 pharmacotherapeutic follow-ups where psychotropic drugs for anxiety, depression and insomnia were registered.
Results: In the actual and potential drug interactions of psychotropic drugs, according to the degree of severity dimension, it was identified that the important indicator represented the highest frequency of 89% of the interactions; according to the type of interaction dimension, it was identified that the pharmacodynamic indicator presented a higher frequency with 53%; according to the clinical evidence dimension, it was identified that the fair indicator had a higher frequency with 73% interactions; in the manifestation dimension, it was identified that the potential indicator presented a higher frequency with 92.2% interactions. In its moment of appearance dimension, it was identified that the quick indicator had a higher prevalence with 5.5% of real interactions. In its causality algorithm dimension, the probable indicator was identified as having the highest frequency with 7.25% of actual interactions. With respect to sex, the male presented 49.9% of potential interactions and in the real interactions, the female sex presented a higher incidence with 4.3% interactions. The average age of the potential interactions was 48.83 years, and the average age of the real interactions was 45.67 years. Sertraline presented 53.2% of potential interactions and in relation to real drug interactions the one that presented the highest frequency was mirtazapine with 3.5% interactions.
Conclusion: We conclude that the increase in the prescription of psychotropic drugs is related to a higher probability of interactions.

Keywords

Drug interactions, real, potential, psychotropic drugs, Covid-19, Hospital, patients, clinical pictures.

Corresponding author: Ambrocio Teodoro Esteves Pairazaman

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2022 Esteves Pairazaman AT et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Esteves Pairazaman AT, Caldas Herrera E, Leon Apac G et al. Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021 [version 1; peer review: 1 not approved]. F1000Research 2022, 11:660 (https://doi.org/10.12688/f1000research.121692.1) First published: 15 Jun 2022, 11:660 (https://doi.org/10.12688/f1000research.121692.1) Latest published: 15 Jun 2022, 11:660 (https://doi.org/10.12688/f1000research.121692.1)

Introduction

On January 30, 2020, the World Health Organization (WHO) Emergency Committee declared COVID-19 a global emergency disease and to date it has claimed thousands of lives in most countries of the world.¹

COVID-19 generates a wide variety of symptomatology ranging from mild symptoms to severe complications such as respiratory failure, cardiac and cardiovascular complications, thrombolytic, inflammatory, skin and neurological complications.²^,³

Among the neuropsychiatric symptoms presented by patients hospitalized for COVID-19 are depression, anxiety, insomnia, agitation and delirium, which affect their mental health. Rogers et al. conducted a systematic review and meta-analysis and revealed that during the acute phase of the disease, hospitalized patients presented symptoms of confusion (27.9%), depressed mood (32.6%), anxiety (35.7%), memory impairment (34.1%) and insomnia (41.9%). And among patients admitted to the intensive care unit (ICU), delirium (65%) and agitation (69%) were evidenced.²^–⁵

The increase in cases of anxiety, depression and insomnia in COVID-19 patients has led to an increase in the prescription of psychotropic drugs. Sanchez and Calvo⁶ indicated that the consumption of anxiolytics increased in Spain during the pandemic from 55.25 to 57.36 defined daily doses per 1,000 inhabitants per day (DHD) during 2019 to 2021 and Shahad et al.⁷ indicated that, during the COVID-19 pandemic, there was an increase in prescribing of Antidepressant prescriptions and costs increased significantly during the pandemic compared to the pre-pandemic period, with 4 million additional prescription items dispensed in 2020 costing NHS England £139 million more than in 2019.

Increased prescribing of psychotropic drugs may contribute to the manifestation of drug–drug interactions and increase the risk of having an adverse reaction due to toxicity and/or therapeutic failure of pharmacotherapeutic treatment due to lower plasma concentrations.

In Germany, Kirilochev et al.,⁸ in their study identified 52 adverse reactions in a psychiatric hospital attributed to drug–drug interactions between antipsychotic drugs and those used for cardiac disorders.

In Peru, Lovera, in his study conducted at the Carlos Lanfranco La Hoz Hospital, evaluated 450 prescriptions where 226 dispensed prescriptions presented potential drug–drug interactions, of which 248 had drug–drug interactions.⁹

In the Villa El Salvador Emergency Hospital, there was an increase in prescriptions of psychotropic drugs indicated for anxiety depression and insomnia in the COVID-19 medicine service, in 2019 there were 911 prescriptions, in 2020 there were 9686 prescriptions and in 2021 there were 14005 prescriptions. Where the increase in the prescriptions of psychotropic drugs can interact with the medication indicated to treat other frequent pathologies in the patient of the COVID-19 medicine service such as arterial hypertension, diabetes mellitus, obesity and over-aggregated infections, which can cause a greater occurrence of drug interactions that produce therapeutic failure, appearance of toxic effects and adverse reactions, increasing the hospital stay and even endangering the patient's life.

The work is justified because, during the pandemic caused by COVID-19, the prescription of psychotropic drugs used in the treatment of anxiety, depression and insomnia has been increasing. The patients of the COVID-19 medicine service present various pathologies such as diabetes, hypertension, obesity, asthma, dyslipidemia, etc. For this reason, they are receiving several medications, which can interact with psychotropic drugs, causing an increase in drug-drug interactions, which can end up putting drug therapy at risk and generate reactions. For this reason, the following work will allow to deepen and update the information on drug-drug interactions of psychotropic drugs that are presented in the COVID-19 medical service and generate a contribution for future research. The study will provide a protocol and instrument, which will be validated by experts, this will allow further research aimed at identifying potential and actual drug–drug interactions in the various hospital services prescribed by the treating physician and will also allow to know what are the main potential and actual drug–drug interactions that occur in psychotropic drugs prescribed for anxiety, depression and insomnia in the COVID-19 medicine service. This will make it possible to reduce and prevent drug–drug interactions.

Finally, the aim of this study is to analyze the actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital during the months of February to July 2021 and to identify the actual and potential drug interactions of psychotropic drugs in terms of degree of severity, type of interaction, clinical evidence, manifestation in patients, time of appearance, causality algorithm and to evaluate the actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital, according to sex and age, with the highest potential and actual frequency.

Methods

The research methodology is deductive and applied-observational. The approach was quantitative because the analysis was observational based on a documentary analysis. At the same time, it was applied and of non-experimental and cross-sectional design. Ethical approval was not required for this section because no humans and/or animals were used.

The population consisted of 86 pharmacotherapeutic follow-ups carried out by the pharmacy unit, where psychotropic drugs for the treatment of anxiety, depression and insomnia were registered for hospitalized patients of the COVID-19 medicine service of the Villa El Salvador Emergency Hospital. Some inclusion and exclusion criteria were applied:

Inclusion criteria:

• Pharmacotherapeutic follow-ups performed by the pharmacy unit on adult patients over 18 years of age.
• Pharmacotherapeutic follow-ups performed by the pharmacy unit during the period from February to July, 2021.
• Pharmacotherapeutic follow-ups performed by the pharmacy unit for patients on the COVID-19 medicine service.
• Pharmacotherapeutic follow-ups carried out by the pharmacy unit where psychotropic drugs for anxiety, depression and insomnia with indications authorized by the National Essential Drug Formulary (sertraline, mirtazapine, clonazapine, clonidine, and other drugs for anxiety, depression and insomnia) are registered, mirtazapine, clonazepam, alprazolam, fluoxetine, amitriptyline, clobazam, diazepam and levomepromazine) and psychotropic drugs approved by the pharmacotherapeutic committee of the Villa El Salvador Emergency Hospital (quetiapine, olanzapine and paroxetine).

Exclusion criteria:

• Pharmacotherapeutic follow-ups performed by the pharmacy unit on patients under 18 years of age.
• Pharmacotherapeutic follow-ups performed by the pharmacy unit on patients who do not correspond to the COVID-19 medicine service.
• Pharmacotherapeutic follow-ups performed by the pharmacy unit that do not correspond to the period of February to July, 2021.
• Pharmacotherapeutic follow-ups performed by the pharmacy unit where no psychotropic drugs for anxiety, depression and insomnia with an indication authorized by the National Essential Drug Formulary (sertraline, mirtazapine, clonazapine, clonidine) have been registered in the pharmacy unit, mirtazapine, clonazepam, alprazolam, fluoxetine, amitriptyline, clobazam, diazepam and levomepromazine) and the psychotropic drugs approved by the pharmacotherapeutic committee of the Villa El Salvador Emergency Hospital (quetiapine, olanzapine and paroxetine).

The sample consisted of 87 pharmacotherapeutic follow-ups carried out by the pharmacy unit, which were chosen by non-probabilistic convenience sampling. The sample consisted of 87 pharmacotherapeutic follow-ups carried out by the pharmacy unit. psychotropic drugs for the treatment of anxiety, depression and insomnia in hospitalized patients of the COVID-19 medicine department of the Villa El Salvador Emergency Hospital.

Pharmacotherapeutic follow-ups were carried out during the period February to July 2021 on patients in the medicine department at the study site.

The instrument used was the data recording form, which consists of the following parts: pharmacotherapeutic follow-up, where the number of pharmacotherapeutic follow-ups will be recorded, age, where the number of years completed will be recorded, interacting drugs, where the drugs will be recorded and whether they present drug interaction with two items (1: Yes; and 2: No): and the score was obtained manually.

Dimension according to type of interaction with four items:

1. Does not present
2. Pharmacokinetics,
3. Pharmacodynamics
4. Unknown.

Dimension according to its degree of severity with six items:

1. Not presented.
2. Contraindicated
3. Important
4. Moderate
5. Minor
6. Unknown

Dimension according to its clinical evidence with five items:

1. Does not present
2. Fair
3. Good
4. Excellent
5. Unknown

Dimension according to its manifestation with two items:

1. Potential
2. Actual

Dimension according to its moment of presentation with four items:

1. No presentation
2. Immediate from 0 to 12 hours
3. Rapid from 12 to 72 hours
4. Delayed more than 72 hours

Dimension according to severity with four items:

1. Does not present
2. Mild
3. Moderate
4. Severe

Dimension according to its causality algorithm with five items:

1. Does not present
2. Highly probable
3. Likely
4. Possible
5. Doubtful

The instrument used was reviewed and approved under the judgement of three experts, who vouched for and validated the form used for its subsequent application.

The method used to estimate the reliability of the instrument was the Cronbach's Alpha Coefficient test, whose alpha value must be between 0.7 and 0.9, which allows the reliability of the questionnaire to be measured. A reliability of 0.702 was obtained according to Cronbach's Alpha Coefficient test.

After collecting the information, all of it was emptied and processed using the SPSS program version 28, and where the interpretation of the results was performed according to the variable and proposed objectives, with the Microsoft Excel 2019 program, frequency tables and graphs were made. The statistical tests used in this research were cross tables and frequencies.

The research project was approved under Resolution N°059-2022-DFFB/UPNW issued by the Faculty of Pharmacy and Biochemistry of the Norbert Wiener University.

For the development of the study, the document “Approval of Research Project N°005-2022” was issued to request authorization from the ethics and research committee of the Villa El Salvador Emergency Hospital. A positive response was received with document "N°61-2022-OGRH-DE-HEVES". With this authorization, we coordinated with the pharmaceutical chemist from the pharmacy service to collect data and draw up a work schedule for the study.

Consent

It should be noted that the development of the research project complied with the ethical principles of the Norbert Wiener University's current regulations and the confidentiality and privacy of the people who were taken as samples for the development of the research will be maintained.

It should also be noted that each person was notified and an informed consent document was received from the patients or relatives who formed part of the study sample, indicating that they are aware of and authorize the provision of data from their medical records for the research.

Results

In Table 1, in relation to the degree of severity of the actual and potential drug interactions of psychotropic drugs, we observed that the important indicator represented the highest frequency with 307 (89%) interactions, followed by the moderate indicator with 22 (6.4%) interactions, then the contraindicated indicator with 16 (4.6%) interactions and the minor and unknown indicators did not present interactions, in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 1. Interactions and potential drug interactions of psychotropic drugs, degree of severity in patients of the COVID-19 Medicine Department of the Villa El Salvador Emergency Hospital.

According to their degree of severity	Frequency n	Percentage
Pharmacodynamics	307	89.0
Pharmacokinetics	22	6.4
Unknown	16	4.6
Total	345	100.0

In Table 2, in relation to actual and potential drug interactions of psychotropic drugs in their interaction type dimension, we observed that the pharmacodynamic indicator had the highest frequency with 183 (53%) interactions, followed by the pharmacokinetic indicator with 93 (27%) interactions and in last place unknown with 69 (20%) interactions, in the patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 2. Interactions and potential drug interactions of psychotropic drugs in their interaction type dimension in patients of the COVID-19 Medicine Department of the Villa El Salvador Emergency Hospital.

By type of interaction	Frequency n	Percentage
Pharmacodynamics	183	53.0
Pharmacokinetics	93	27.0
Unknown	69	20.0
Total	345	100.0

In Table 3, in relation to actual and potential drug interactions of psychotropic drugs in its clinical evidence dimension, we observed that the indicator fair had a higher frequency with 252 (73%) interactions, followed by the indicator good with 72 (20.9%) interactions, then excellent with 21 (6.1%) interactions and in last place to unknown with 0 (0%) interactions, in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 3. Actual and potential drug interactions of psychotropic drugs in their clinical evidence dimension in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Based on clinical evidence	Frequency n	Percentage
Fair	252	73.0
Good	72	20.9
Excellent	21	6.1
Unknown	0	0
Total	345	100.0

In Table 4, in relation to actual and potential drug interactions of psychotropic drugs in its manifestation dimension, we observed that the potential indicator presented a higher frequency with 318 (92.2%) interactions, compared to the actual indicator with 23 (7.8%) interactions, in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 4. Actual and potential drug interactions of psychotropic drugs in their manifestation dimension in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

According to your statement	Frequency n	Percentage
Potential	318	92.2
Actual	27	7.8
Total	345	100.0

In Table 5, in relation to real and potential drug interactions of psychotropic drugs in their time of appearance dimension, we observed that the indicator did not present a higher frequency with 318 (92.2%) potential interactions, followed by the fast indicator with 19 (5.5%) real interactions, then late with 8 (2.32%) real interactions and in last place immediate with 0 (0%) real interactions, in the patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 5. Actual and potential drug-drug interactions of psychotropic drugs in their time-of-onset dimension in patients of the COVID-19 Medicine Department of the Villa El Salvador Emergency Hospital.

According to their time of appearance	Frequency n	Percentage
Does not present	318	92.2
Fast	19	5.5
Late	8	2.3
Immediate	0	0
Total	345	100.0

In Table 6, in relation to actual and potential drug interactions of psychotropic drugs in its causality algorithm dimension, the indicator does not present a higher frequency with 318 (92.2%) potential interactions, in second place the probable indicator with 25 (7.25%) actual interactions, in third place possible with 2 (0.58%) actual interactions and the indicators highly probable and doubtful in last place with 0 (0%) actual interactions each, in the patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 6. Actual and potential drug interactions of psychotropic drugs in their causality algorithm dimension in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

According to the causality algorithm	Frequency n	Percentage
Does not present	318	92.2
Likely	25	7.2
Possible	2	0.6
Highly probable	0	0
Doubtful	0	0
Total	345	100.0

In Table 7, in relation to actual and potential drug interactions of psychotropic drugs according to sex, it was observed that the male sex presented a higher frequency in potential interactions with 172 (49.9%) interactions compared to the female sex with 146 (42.3%) interactions and in actual interactions the female sex presented a higher incidence with 15 (4.3%) interactions compared to the male sex that presented 12 (3.5%) interactions, in the patients of the COVID-19 Medicine Service of the Emergency Hospital of Villa El Salvador.

Table 7. Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital according to sex.

Drug interaction	Male	Female
Real	12	15
% within interaction	44.4%	55.6%
% within gender	6.5%	9.3%
% of total	3.5%	4.3%
Potential	172	146
% within interaction	54.1%	45.9%
% within gender	93.5%	90.7%
% of total	49.9%	42.3%
Total	184	161
% within interaction	53.3%	46.7%
% within gender	100.0%	100.0%
% of total	53.3%	46.7%

In Table 8, in relation to real and potential drug interactions of psychotropic drugs according to age, showed that the average age was 48.58 years, the average age of potential interactions was 48.83 years, and the average age of real interactions was 45.67 years, in the patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 8. Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital according to age.

Interaction	Interactions n	Average years
Real	27	45.67
Potential	318	48.83
Total	345	48.58

In Table 9, in relation to the psychotropic drugs with the highest frequency of potential drug interactions it was observed that sertraline in first place with 184 (53.2%) interactions, in second place, mirtazapine with 56 (16. 2%) interactions, in third place, clonazepam with 41 (11.9%) interactions and in fourth, fifth, sixth, seventh, eighth and ninth alprazolam, quetiapine, levomepromazine, fluoxetine, amitriptyline and olanzapine. In relation to actual drug interactions, mirtazapine had 12 (3.5%) interactions in first place, clonazepam and sertraline had 7 (2%) interactions each, olanzapine had 1 (0.3%) interaction in third place, and alprazolam, quetiapine, levomepromazine, fluoxetine and amitriptyline had no interactions in the patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 9. Psychotropic drugs with the highest frequency of actual and potential drug-drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Psychotropic drugs	Potential		Real		Total
Psychotropic drugs	n	%	n	%	n	%
Mirtazapine	56	16.20%	12	3.50%	68	19.70%
Clonazepam	41	11.90%	7	2.00%	48	13.90%
Sertraline	184	53.30%	7	2.00%	191	55.40%
Olanzapine	0	0.00%	1	0.30%	1	0.30%
Alprazolam	15	4.30%	0	0.00%	15	4.30%
Fluoxetine	6	1.70%	0	0.00%	6	1.70%
Levomepromazine	2	0.60%	0	0.00%	2	0.60%
Amitriptyline	1	0.30%	0	0.00%	1	0.30%
Quetiapine	13	3.80%	0	0.00%	13	3.80%
Total	318	92.20%	27	7.80%	345	100%

In Table 10, in relation to the psychotropic drugs with the highest frequency of actual and potential drug interactions of psychotropic drugs it was evidenced that sertraline with enoxaparin ranked first with 50 (14.49%) interactions, in second place mirtazapine with clonazepam 6.40%, in third place clonazepam with gabapentin with 11 (3.19%) interactions, in fourth place alprazolam with codeine 4 (1.16%) hospitalizations, in fifth place quetiapine with gabapentin and quetiapine with metoclopramide with 3 (0.87%) interactions each, in seventh place fluoxetine with sulpiride with 2 (0.58%) interactions and seventh place amitriptyline with dextromethorphan and olanzapine with valproic acid with 1 (0.29%) interaction, in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 10. Psychotropic drugs with the highest frequency of actual and potential drug-drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Interacting medicines	Sertraline%	Mirtazapine %	Clonazepam %	Alprazolam %	Quetiapine %	Fluoxetine %	Levomepromazine %	Amitriptyline %	Olanzapine %	Total %
Enoxaparin	0.00	14.50	0.00	0.00	0.30	0.00	0.00	0.00	0.00	14.80
Dextromethorphan	2.60	4.60	1.40	0.60	0.00	0.30	0.00	0.60	0.00	10.10
Tramadol	0.00	5.50	2.90	0.00	0.00	0.00	0.30	0.00	0.00%	8.70
Mirtazapine	2.30	3.50%	1.70	0.60	0.30	0.00	0.00	0.00	0.00	8.40
Alprazolam	1.70	2.90	2.00	1.20	0.00	0.00	0.00	0.00	0.00	7.80
Morphine	2.60	3.20	0.00	0.30	0.30	0.00	0.00	0.90	0.00	7.20
Metoclopramida	0.00	0.00	6.40	0.00	0.00	0.00	0.00	0.00	0.00	6.40
Codeine	0.00	3.80	1.20	0.00	0.00	0.00	0.00	0.00	0.00	4.90
Haloperidol	3.20	0.00	0.00	0.30	0.00	0.30	0.00	0.90	0.00	4.60
Quetiapine	0.00	2.90	0.00	0.90	0.00	0.00	0.00	0.60	0.00	4.30
Risperidona	0.00	4.10	0.00	0.00	0.00	0.00	0.00	0.00	0.00	4.10
Rifampicin	0.00	2.00	0.60	0.00	0.30	0.00	0.00	0.00	0.00	2.90
Ciprofloxacin	0.00	2.00	0.30	0.00	0.00	0.00	0.00	0.30	0.00	2.60
Levofloxacin	0.00	0.90	0.30	0.30	0.00	0.00	0.00	0.00	0.00	1.40
Fluconazol	0.30	0.60	0.60	0.00	0.00	0.00	0.00	0.00	0.00	1.40
Phenytoin	0.00	0.90	0.30	0.00	0.00	0.00	0.00	0.30	0.00	1.40
Sulpirida	0.00	1.20	0.00	0.00	0.00	0.00	0.00	0.00	0.00	1.20
Azithromycin	0.60	0.00	0.60	0.00	0.00	0.00	0.00	0.00	0.00	1.20
Aspirin	0.00	0.30	0.00	0.00	0.60	0.00	0.00	0.00	0.00	0.90
Cilostazol	0.60	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.90
Amitriptyline	0.00	0.60	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.60
Metronidazol	0.00	0.30	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.60
Olanzapine	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Heparin	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Clonazepam	0.00	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Gabapentin	0.00	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Carbamazepine	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Midazolam	0.00	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Sertraline	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Levomerpromazine	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30	0.30
Warfarin	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Ac. Valproic	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30	0.00	0.30
Escopolamine	0.00	0.00	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.30
Ranitidine	0.00	0.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.30
Total	13.90	55.40	19.70	4.30	1.70	0.60	0.30	3.80	0.30	100.00

In Table 11, in relation to the actual drug interactions that were manifested, it can be seen that somnolence presented the highest frequency with 18 (66.7%) actual interactions, followed by depression with 3 (11.1%) actual interactions and anxiety, muscular weakness, INR elevation, hematochezia, hemoptysis and dizziness in third place with 1 (3.7%) actual interaction for each one, in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 11. Description of actual drug-drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Description of the actual interaction	Frequency n	Percentage
Drowsiness	18	66.7%
Depression	3	11.1%
Anxiety	1	3.7%
Muscle weakness	1	3.7%
Elevated INR	1	3.7%
Hematochezia	1	3.7%
Hemoptysis	1	3.7%
Dizziness	1	3.7%
Total	27	100.0%

Discussion and conclusion

The most significant constraint during the research process was the limited time taken to collect the data, as the hospital did not authorise the document in a timely manner.

Regarding actual and potential drug interactions of psychotropic drugs in their degree of severity dimension, the important indicator represented the highest frequency with 307 (89%) interactions, followed by the moderate indicator with 22 (6.4%) interactions, then the contraindicated indicator with 16 (4.6%) interactions and the minor and unknown indicators did not present interactions, similar results were obtained in the studies Lovera,⁹ Palomino and Rojas,¹⁰ Candia Bruno and Candia Bruno,¹¹ Kirilochev et al.,¹² Zapelini et al.¹³ Where the important indicator also presented greater frequency, different values were obtained in the study of Escarza and Salas¹⁴ where the indicator with greater frequency was moderate, this difference is probably since all the psychotropic drugs prescribed in the hospital center were included, as opposed to this study which only included psychotropic drugs indicated for anxiety, depression, and insomnia.

In relation to real and potential drug interactions of psychotropic drugs in its interaction type dimension, the pharmacodynamic indicator obtained a higher frequency with 183 (53%) interactions, followed by the pharmacokinetic indicator with 93 (27%) interactions and in the last place unknown with 69 (20%) interactions, similar results were obtained in the studies Lovera,⁹ Palomino, Rojas,¹⁰ Escarza and Salas¹⁴ and Montes and Ramos.¹⁵ Where the pharmacodynamic indicator presented higher prevalence, a different result was obtained by Zapelini et al.¹³ where the most frequent indicator was pharmacokinetics, this difference is probably due to the sample size of 2320 clinical histories and all psychotropic drugs prescribed in a hospital center were included, unlike this study which only included psychotropic drugs indicated for anxiety, depression and insomnia, and the sample size was 86 pharmacotherapeutic follow-ups.

Regarding actual and potential drug interactions of psychotropic drugs in its clinical evidence dimension, we observed that the indicator fair had a higher frequency with 252 (73%) interactions, followed by the indicator good with 72 (20.9%) interactions, then excellent with 21 (60.1%) interactions and lastly unknown with 0 (0%) interactions. This difference is probably due to the size of the sample of 450 prescriptions, unlike this study which only included psychotropic drugs indicated for anxiety, depression and insomnia, and the sample size of 86 pharmacotherapeutic follow-ups.

In relation to actual and potential drug interactions of psychotropic drugs in their manifestation dimension, we observed that the potential indicator presented a higher frequency with 318 (92.2%) interactions, compared to the actual indicator with 23 (7.8%) interactions, a similar result was obtained in the study conducted by Montes and Ramos¹⁵ where potential interactions had a higher prevalence.

Regarding the image in relation to actual and potential drug interactions of psychotropic drugs in their time of onset dimension, we observed that the indicator did not present a higher frequency with 318 (92.2%) potential interactions, followed by the fast indicator with 19 (5.5%) actual interactions, then late with 8 (2.32%) actual interactions and lastly immediate with 0 (0%) actual interactions. A different result was obtained by Zevallos¹⁶ where slow had a higher prevalence of 48% and fast 16.3%, this difference is probably due to the fact that this study was carried out on all drugs prescribed in the medical service, unlike this study which only included psychotropic drugs indicated for anxiety, depression and insomnia.

In relation to the actual and potential drug interactions of psychotropic drugs in its causality algorithm dimension, the indicator did not present the highest frequency with 318 (92.2%) potential interactions, in second place, the probable indicator with 25 (7.25%) actual interactions, third place, possible with 2 (0.58%) actual interactions and the immediate highly probable and doubtful indicators in last place with 0 (0%) actual interactions each. 25%) real interactions, in third place, possible with 2 (0.58%) real interactions and the immediate indicators highly probable and doubtful in last place with 0 (0%) real interactions each, a different result obtained by Castro and Monroy¹⁷ where the indicator with the highest presence was possible with 8.3%. This difference is probably due to the fact that the sample of this study is smaller, with seven follow-ups, compared to this study, where the sample is made up of 86 follow-ups.

Regarding the actual and potential drug interactions of psychotropic drugs according to sex, it was observed that the male sex presented higher frequency in the potential interactions with 172 (49.9%) interactions compared to the female sex with 146 (42.3%) interactions and in the actual interactions the female sex presented higher incidence with 15 (4.3%) interactions compared to the male sex that presented 12 (3.5%) interactions, unlike the studies conducted by Palomino and Rojas¹⁰ and Jan Wolff et al.¹⁸ where the female sex presented a higher frequency; however, similarity was found in the results obtained in the studies by Montes and Ramos¹⁵ and Candía Bruno and Candia Bruno¹¹ where the male sex presented a higher frequency. This difference between the results obtained and this study is probably since COVID-19 affects the male sex more.

In relation to real and potential drug interactions of psychotropic drugs according to their age, it was found that the average age was 48.58 years, of the potential interactions the average age was 48.83 years and of the real interactions it was 45.67, a different result obtained by Montes and Ramos¹⁵ where the average age was in the range of 24 and maximum of 36 years, probably because COVID-19 affects older adults more.

As for the psychotropic drugs that presented the highest frequency of potential drug interactions was sertraline with 184 (53.2%) and in relation to real drug interactions, the one that presented the highest frequency was mirtazapine with 12 (3.5%) interactions. Different results were obtained by Palomino and Rojas,¹⁰ Kirilochev et al.¹² and Escarza and Salas,¹⁴ where sertraline was in third place, in the second study sertraline was in seventh place and in the second study sertraline was in second place with 13.5%.

The most frequent drug-drug interaction was sertraline with enoxaparin with 50 (14.49%) interactions. A different result was obtained by Lovera⁹ and Escarza and Salas¹⁴ where clonazepam-sertraline was the most frequent interaction in both studies, probably due to the symptomatic treatment indicated for COVID-19 where enoxaparin is indicated for hypercoagulability.

And in relation to real drug interactions, somnolence presented the greatest frequency with 18 (66.7%) real interactions, in second place, depression with 3 (11.1%) real interactions and anxiety, muscular weakness, INR elevation, hematochezia, hemoptysis and dizziness in third place with 1 (3.7%). Similar results were obtained by Montes and Ramos¹⁵ where extrapyramidal and sedation effects were more frequent, probably due to the central nervous system depressant effect of psychotropic drugs.

In conclusion, it was identified that the male sex presented a higher frequency in the potential interactions with 172 (49.9%) interactions and in the real interactions the female sex presented a higher incidence with 15 (4.3%) interactions, it was also identified that the average age was 48.58 years, in the potential interactions the average age was 48.83 years and in the real interactions it was 45.67 years. In turn, it was identified that the psychotropic drug that presented the highest frequency in potential drug interactions was sertraline with 184 (53.2%) and in relation to real drug interactions the one that presented the highest frequency was mirtazapine with 12 (3.5%) interactions and that the most frequent interaction was sertraline with enoxaparin with 50 (14.49%) interactions and finally it was identified that somnolence was the main adverse event that occurred with 18 (66.7%) cases.

Data availability

[Repository name: ZENODO] [Data file title: Actual and potential drug interactions of psychotropic drugs in patients of the covid-19 medicine service of the Hospital de Emergencia-Lima, 2021] [DOI: 10.5281/zenodo.6499337. https://zenodo.org/record/6499337#.Ymmo89pBy3A] [License details: Open Access].¹⁹

References

1. Carlos C: Universidad Privada Antenor Orrego Facultad De Medicina Humana Escuela Profesional De Medicina Humana Tesis Para Optar El Título Profesional De Médico Cirujano.Reference Source
2. Mcintosh K: UPTODATE. Martin S hirsch, MD. 2021.Reference Source Reference Source
3. Jiménez V: Uso de psicofármacos para síntomas neuropsiquiátricos en pacientes hospitalizados con covid-19. Horizonte médico (Lima). 2021 May 21; 21(2): e1272. Publisher Full Text
4. B Stein M: UPTODATE.2021 [cited 2021 nov 21].Reference Source Reference Source
5. Apaza MV: Tesis para optar el título profesional de médico cirujano autora vicerrectorado de investigación.2020 [cited 2021 Nov 21].Reference Source
6. Díaz S, Calvo M: ml. Trends in the use of anxiolytics in castile and leon, spain, between 2015–2020: evaluating the impact of covid-19. Int. J. Environ. Res. Public Health. 2021 Jun 1 [cited 2021 Nov 21]; 18(11): 5944. PubMed Abstract | Publisher Full Text Reference Source
7. Shahad AR, Hamid AM: Surging trends in prescriptions and costs of antidepressants in england amid covid-19. DARU J. Pharm. Sci. 2021 Mar 13.
8. Chesney E: Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the covid-19 pandemic. Lancet Psychiatry. 2020 May; 7(7): 611–627. Publisher Full Text
9. Lovera TM: Identificación de interacciones medicamentosas potenciales en recetas médicas atendidas en la farmacia ambulatoria del hospital carlos lanfranco la hoz, periodo setiembre - noviembre 2018.2019 [cited 2021 Nov 21].Reference Source
10. Palomino Torres E, Rojas CE: Interacciones medicamentosas potenciales en las prescripciones médicas de los fármacos psicotrópicos atendidas en la farmacia universal sede lima periodo enero – julio 2016.2018.Reference Source
11. Candia Bruno N, Candia Bruno Y: Interacciones Medicamentosas Potenciales En El Departamento De Medicina Del Hospital Militar Central Enero - Setiembre 2019 tesis para optar el título profesional de químico farmacéutico autores.2020 [cited 2021 Nov 21].Reference Source
12. Kirilochev OO: Interacciones fármaco-fármaco en el tratamiento de pacientes en condiciones.hospital psiquiátrico.2017 [cited 2021 Nov 21].Www.mediasphera.ru Reference Source
13. Zapelini Do Nascimento D, Gm M, Schuelter-Trevisol F: Potential psychotropic drug interactions among drug-dependent people. J. Psychoactive Drugs. 2020 Nov 22; 30: 1–9. Publisher Full Text
14. Escarza Aquino K, Salas MK: Interacciones medicamentosas potenciales en prescripciones médicas de pacientes ambulatorios del servicio de psiquiatría Del Hospital III De Emergencias Grau Essalud, periodo abril - noviembre del 2017.2021.Reference Source
15. Montes Sence MM, Ramos Quispe CR: Evaluación del uso de psicofármacos en pacientes con trastornos mentales del Hospital De Salud Mental “SAN JUAN PABLO II EN EL PERIODO 2014-2015 Universidad Nacional De San Antonio Abad Del Cusco Facultad De Ciencias De La Salud Escuela Profesional De Farmacia y Bioquímica Tesis.2017 [cited 2021 Nov 21].Reference Source
16. Zevallos S: Interacciones medicamentosas de relevancia clínica en el Servicio de Medicina del Hospital Regional de Ayacucho de febrero a julio 2019. Edu.pe.2019 [citado el 9 de marzo de 2022].Reference Source
17. Castro MJ, Monroy J: Interacciones medicamentosas potenciales en pacientes crónicos con esquizofrenia hospitalizados en una clínica de bogotá d.c., durante el período enero a febrero del año 2018. Edu.co.2018 [citado el 9 de marzo de 2022]. Reference Source
18. Wolff J, Kaier K, Toto S: Polypharmacy and the risk of drug–drug interactions and potentially inappropriate medications in hospital psychiatry. Pharmacoepidemiol. Drug Saf. 2021 Jun 24; 30(9): 1258–1268. PubMed Abstract | Publisher Full Text
19. PAIRAZAMAN ATE, et al.: Underlying data for: Actual and potential drug interactions of psychotropic drugs in patients of the covid-19 medicine service of the Hospital de Emergencia-Lima, 2021. [data].2022. Publisher Full Text

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Author details Author details

¹ Facultad de Farmacia y Bioquímica, Universidad Privada Norbert Wiener, Lima, Lima, 15072, Peru

Ambrocio Teodoro Esteves Pairazaman
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Supervision

Emma Caldas Herrera
Roles: Methodology, Supervision

Gabriel Leon Apac
Roles: Data Curation, Writing – Review & Editing

Jesús Daniel Collanque Pinto
Roles: Writing – Review & Editing

María Evelina Caldas Herrera
Roles: Writing – Review & Editing

Daniel Ñañez del Pino
Roles: Writing – Review & Editing

Javier Francisco Martínez Carreras
Roles: Writing – Original Draft Preparation

Ricardo Robles Huaranca
Roles: Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Esteves Pairazaman AT, Caldas Herrera E, Leon Apac G et al. Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021 [version 1; peer review: 1 not approved]. F1000Research 2022, 11:660 (https://doi.org/10.12688/f1000research.121692.1)

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Reviewer Report 10 Sep 2024

Aybeniz Civan Kahve, Gazi University, ankara, Turkey

Not Approved

https://doi.org/10.5256/f1000research.133586.r175595

First of all, thank you for giving me the opportunity to review the article. Researchers have investigated drug-drug interactions in psychotropics used in the emergency department over a five-month period during the COVID-19 pandemic. Here are my suggestions that I ... Continue reading

First of all, thank you for giving me the opportunity to review the article. Researchers have investigated drug-drug interactions in psychotropics used in the emergency department over a five-month period during the COVID-19 pandemic. Here are my suggestions that I think will help the authors:

The summary of the article needs to be rewritten. What system did the authors use to evaluate drug interactions? By which analysis were the rates given in the findings obtained? What are the targeted drug groups? I suggest you write them in the summary. It is more important that they give the interactions rather than the ratios of the findings.
Introduction: “Increased prescribing of psychotropic drugs may contribute to the manifestation of drug–drug interactions and increase the risk of having an adverse reaction due to toxicity and/or therapeutic failure of pharmacotherapeutic treatment due to lower plasma concentrations.”. The decrease in drug level is not the only reason for the decrease in pharmacotherapeutic efficacy. Pharmacodynamic interactions at the receptor level may also lead to decreased efficacy. Therefore, I suggest saying that there may be a loss of efficacy due to pharmacokinetic and pharmacodynamic interactions.
Introduction: “In the Villa El Salvador Emergency Hospital, there was an increase in prescriptions of psychotropic drugs indicated for anxiety depression and insomnia in the COVID-19 medicine service, in 2019 there were 911 prescriptions, in 2020 there were 9686 prescriptions and in 2021 there were 14005 prescriptions. Where the increase in the prescriptions of psychotropic drugs can interact with the medication indicated to treat other frequent pathologies in the patient of the COVID-19 medicine service such as arterial hypertension, diabetes mellitus, obesity and over-aggregated infections, which can cause a greater occurrence of drug interactions that produce therapeutic failure, appearance of toxic effects and adverse reactions, increasing the hospital stay and even endangering the patient's life.” It may make it more understandable if you write the sentences in this paragraph shorter and in splits.
Introduction: “The work is justified because, during the pandemic caused by COVID-19, the prescription of psychotropic drugs used in the treatment of anxiety, depression and insomnia has been increasing. The patients of the COVID-19 medicine service present various pathologies such as diabetes, hypertension, obesity, asthma, dyslipidemia, etc. For this reason, they are receiving several medications, which can interact with psychotropic drugs, causing an increase in drug-drug interactions, which can end up putting drug therapy at risk and generate reactions. For this reason, the following work will allow to deepen and update the information on drug-drug interactions of psychotropic drugs that are presented in the COVID-19 medical service and generate a contribution for future research. The study will provide a protocol and instrument, which will be validated by experts, this will allow further research aimed at identifying potential and actual drug–drug interactions in the various hospital services prescribed by the treating physician and will also allow to know what are the main potential and actual drug–drug interactions that occur in psychotropic drugs prescribed for anxiety, depression and insomnia in the COVID-19 medicine service. This will make it possible to reduce and prevent drug–drug interactions.” The entry contains too much repetitive information. The fact that patients have additional medical conditions may increase the number of drugs used and cause more drug-drug interactions. That's enough to write. In addition, the purpose of the study has already been stated in the next paragraph. I think that it is not suitable for a portable introduction to the end of the discussion to guide future studies.
It was said that there is no need for ethical approval, but the research approval has already been obtained from the university. People and their relatives were also informed that their data was used. This data is not open data. It is obtained by examining the drug treatment records of people from hospital information systems. Therefore, ethical compliance decision is needed. “Ethical approval was not required for this section because no humans and/or animals were used.” Could this sentence be written in methods mistakenly??
Illuminate in the method of operation. Is approval required for the use of psychotropic medication in your hospital's emergency department? How does the Pharmacy unit work? For whom does he follow up? Which unit is this approval made by? Have you considered all psychotropics approved by that unit?
I think this paragraph is unnecessary in exclusion criteria. “Pharmacotherapeutic follow-ups performed by the pharmacy unit where no psychotropic drugs for anxiety, depression and insomnia with an indication authorized by the National Essential Drug Formulary (sertraline, mirtazapine, clonazepam, clonidine) have been registered in the unit, mirtazapine, clonazepam , alprazolam, fluoxetine, amitriptyline, clobazam, diazepam and levomepromazine) and the psychotropic drugs approved by the pharmacotherapeutic committee of the Villa El Salvador Emergency Hospital (quetiapine, olanzapine and paroxetine).”
Are the specified scales and questions evaluated and filled by the pharmacologist over all the drugs and recorded data of the patients? Explain this a little.
What are the unknown interactions in Table 1? Can you explain what is called unknown under the table and in the text? Unknown if there is interaction or not??
The difference between table 1 and table 2 cannot be understood. The two tables can be combined and the difference in table 2 compared to table 1 can be explained.
Table 3 – according to what is the categorization called fair good excellent etc.? Here, it should be explained what is taken into consideration in scoring the method.
I think there is no need to mention the location in every finding and table: COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.
For what hour/day was the word fast late immediate for Table 5?
How was causality evaluated in Table 6? We do not know the evaluation conditions of any scale. In Table 8, which one is real and which potential is decided based on what?
The way of evaluating the evaluation dimensions of drug interaction is very inadequate. I did not find the article understandable. Tables can be combined I think 11 tables make it difficult to follow.
The discussion was data repetition. It needs rewriting.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Psychopharmacology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Aybeniz Civan Kahve, Gazi University, ankara, Turkey

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Reviewer Report

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10 Sep 2024 | for Version 1

Aybeniz Civan Kahve, Gazi University, ankara, Turkey

3 Views Cite this report Responses(0)

Not Approved

First of all, thank you for giving me the opportunity to review the article. Researchers have investigated drug-drug interactions in psychotropics used in the emergency department over a five-month period during the COVID-19 pandemic. Here are my suggestions that I think will help the authors:

The summary of the article needs to be rewritten. What system did the authors use to evaluate drug interactions? By which analysis were the rates given in the findings obtained? What are the targeted drug groups? I suggest you write them in the summary. It is more important that they give the interactions rather than the ratios of the findings.
Introduction: “Increased prescribing of psychotropic drugs may contribute to the manifestation of drug–drug interactions and increase the risk of having an adverse reaction due to toxicity and/or therapeutic failure of pharmacotherapeutic treatment due to lower plasma concentrations.”. The decrease in drug level is not the only reason for the decrease in pharmacotherapeutic efficacy. Pharmacodynamic interactions at the receptor level may also lead to decreased efficacy. Therefore, I suggest saying that there may be a loss of efficacy due to pharmacokinetic and pharmacodynamic interactions.
Introduction: “In the Villa El Salvador Emergency Hospital, there was an increase in prescriptions of psychotropic drugs indicated for anxiety depression and insomnia in the COVID-19 medicine service, in 2019 there were 911 prescriptions, in 2020 there were 9686 prescriptions and in 2021 there were 14005 prescriptions. Where the increase in the prescriptions of psychotropic drugs can interact with the medication indicated to treat other frequent pathologies in the patient of the COVID-19 medicine service such as arterial hypertension, diabetes mellitus, obesity and over-aggregated infections, which can cause a greater occurrence of drug interactions that produce therapeutic failure, appearance of toxic effects and adverse reactions, increasing the hospital stay and even endangering the patient's life.” It may make it more understandable if you write the sentences in this paragraph shorter and in splits.
Introduction: “The work is justified because, during the pandemic caused by COVID-19, the prescription of psychotropic drugs used in the treatment of anxiety, depression and insomnia has been increasing. The patients of the COVID-19 medicine service present various pathologies such as diabetes, hypertension, obesity, asthma, dyslipidemia, etc. For this reason, they are receiving several medications, which can interact with psychotropic drugs, causing an increase in drug-drug interactions, which can end up putting drug therapy at risk and generate reactions. For this reason, the following work will allow to deepen and update the information on drug-drug interactions of psychotropic drugs that are presented in the COVID-19 medical service and generate a contribution for future research. The study will provide a protocol and instrument, which will be validated by experts, this will allow further research aimed at identifying potential and actual drug–drug interactions in the various hospital services prescribed by the treating physician and will also allow to know what are the main potential and actual drug–drug interactions that occur in psychotropic drugs prescribed for anxiety, depression and insomnia in the COVID-19 medicine service. This will make it possible to reduce and prevent drug–drug interactions.” The entry contains too much repetitive information. The fact that patients have additional medical conditions may increase the number of drugs used and cause more drug-drug interactions. That's enough to write. In addition, the purpose of the study has already been stated in the next paragraph. I think that it is not suitable for a portable introduction to the end of the discussion to guide future studies.
It was said that there is no need for ethical approval, but the research approval has already been obtained from the university. People and their relatives were also informed that their data was used. This data is not open data. It is obtained by examining the drug treatment records of people from hospital information systems. Therefore, ethical compliance decision is needed. “Ethical approval was not required for this section because no humans and/or animals were used.” Could this sentence be written in methods mistakenly??
Illuminate in the method of operation. Is approval required for the use of psychotropic medication in your hospital's emergency department? How does the Pharmacy unit work? For whom does he follow up? Which unit is this approval made by? Have you considered all psychotropics approved by that unit?
I think this paragraph is unnecessary in exclusion criteria. “Pharmacotherapeutic follow-ups performed by the pharmacy unit where no psychotropic drugs for anxiety, depression and insomnia with an indication authorized by the National Essential Drug Formulary (sertraline, mirtazapine, clonazepam, clonidine) have been registered in the unit, mirtazapine, clonazepam , alprazolam, fluoxetine, amitriptyline, clobazam, diazepam and levomepromazine) and the psychotropic drugs approved by the pharmacotherapeutic committee of the Villa El Salvador Emergency Hospital (quetiapine, olanzapine and paroxetine).”
Are the specified scales and questions evaluated and filled by the pharmacologist over all the drugs and recorded data of the patients? Explain this a little.
What are the unknown interactions in Table 1? Can you explain what is called unknown under the table and in the text? Unknown if there is interaction or not??
The difference between table 1 and table 2 cannot be understood. The two tables can be combined and the difference in table 2 compared to table 1 can be explained.
Table 3 – according to what is the categorization called fair good excellent etc.? Here, it should be explained what is taken into consideration in scoring the method.
I think there is no need to mention the location in every finding and table: COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.
For what hour/day was the word fast late immediate for Table 5?
How was causality evaluated in Table 6? We do not know the evaluation conditions of any scale. In Table 8, which one is real and which potential is decided based on what?
The way of evaluating the evaluation dimensions of drug interaction is very inadequate. I did not find the article understandable. Tables can be combined I think 11 tables make it difficult to follow.
The discussion was data repetition. It needs rewriting.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Psychopharmacology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

Responses (0)

[1] 1. Carlos C: Universidad Privada Antenor Orrego Facultad De Medicina Humana Escuela Profesional De Medicina Humana Tesis Para Optar El Título Profesional De Médico Cirujano.Reference Source

[2] 2. Mcintosh K: UPTODATE. Martin S hirsch, MD. 2021.Reference Source Reference Source

[3] 3. Jiménez V: Uso de psicofármacos para síntomas neuropsiquiátricos en pacientes hospitalizados con covid-19. Horizonte médico (Lima). 2021 May 21; 21(2): e1272. Publisher Full Text

[4] 4. B Stein M: UPTODATE.2021 [cited 2021 nov 21].Reference Source Reference Source

[5] 5. Apaza MV: Tesis para optar el título profesional de médico cirujano autora vicerrectorado de investigación.2020 [cited 2021 Nov 21].Reference Source

[6] 6. Díaz S, Calvo M: ml. Trends in the use of anxiolytics in castile and leon, spain, between 2015–2020: evaluating the impact of covid-19. Int. J. Environ. Res. Public Health. 2021 Jun 1 [cited 2021 Nov 21]; 18(11): 5944. PubMed Abstract | Publisher Full Text Reference Source

[7] 7. Shahad AR, Hamid AM: Surging trends in prescriptions and costs of antidepressants in england amid covid-19. DARU J. Pharm. Sci. 2021 Mar 13.

[8] 8. Chesney E: Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the covid-19 pandemic. Lancet Psychiatry. 2020 May; 7(7): 611–627. Publisher Full Text

[9] 9. Lovera TM: Identificación de interacciones medicamentosas potenciales en recetas médicas atendidas en la farmacia ambulatoria del hospital carlos lanfranco la hoz, periodo setiembre - noviembre 2018.2019 [cited 2021 Nov 21].Reference Source

[10] 10. Palomino Torres E, Rojas CE: Interacciones medicamentosas potenciales en las prescripciones médicas de los fármacos psicotrópicos atendidas en la farmacia universal sede lima periodo enero – julio 2016.2018.Reference Source

[11] 11. Candia Bruno N, Candia Bruno Y: Interacciones Medicamentosas Potenciales En El Departamento De Medicina Del Hospital Militar Central Enero - Setiembre 2019 tesis para optar el título profesional de químico farmacéutico autores.2020 [cited 2021 Nov 21].Reference Source

[12] 12. Kirilochev OO: Interacciones fármaco-fármaco en el tratamiento de pacientes en condiciones.hospital psiquiátrico.2017 [cited 2021 Nov 21].Www.mediasphera.ru Reference Source

[13] 13. Zapelini Do Nascimento D, Gm M, Schuelter-Trevisol F: Potential psychotropic drug interactions among drug-dependent people. J. Psychoactive Drugs. 2020 Nov 22; 30: 1–9. Publisher Full Text

[14] 14. Escarza Aquino K, Salas MK: Interacciones medicamentosas potenciales en prescripciones médicas de pacientes ambulatorios del servicio de psiquiatría Del Hospital III De Emergencias Grau Essalud, periodo abril - noviembre del 2017.2021.Reference Source

[15] 15. Montes Sence MM, Ramos Quispe CR: Evaluación del uso de psicofármacos en pacientes con trastornos mentales del Hospital De Salud Mental “SAN JUAN PABLO II EN EL PERIODO 2014-2015 Universidad Nacional De San Antonio Abad Del Cusco Facultad De Ciencias De La Salud Escuela Profesional De Farmacia y Bioquímica Tesis.2017 [cited 2021 Nov 21].Reference Source

[16] 16. Zevallos S: Interacciones medicamentosas de relevancia clínica en el Servicio de Medicina del Hospital Regional de Ayacucho de febrero a julio 2019. Edu.pe.2019 [citado el 9 de marzo de 2022].Reference Source

[17] 17. Castro MJ, Monroy J: Interacciones medicamentosas potenciales en pacientes crónicos con esquizofrenia hospitalizados en una clínica de bogotá d.c., durante el período enero a febrero del año 2018. Edu.co.2018 [citado el 9 de marzo de 2022]. Reference Source

[18] 18. Wolff J, Kaier K, Toto S: Polypharmacy and the risk of drug–drug interactions and potentially inappropriate medications in hospital psychiatry. Pharmacoepidemiol. Drug Saf. 2021 Jun 24; 30(9): 1258–1268. PubMed Abstract | Publisher Full Text

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Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 medicine service of the emergency hospital-Lima, 2021

Abstract

Keywords

Introduction

Methods

Consent

Results

Table 1. Interactions and potential drug interactions of psychotropic drugs, degree of severity in patients of the COVID-19 Medicine Department of the Villa El Salvador Emergency Hospital.

Table 2. Interactions and potential drug interactions of psychotropic drugs in their interaction type dimension in patients of the COVID-19 Medicine Department of the Villa El Salvador Emergency Hospital.

Table 3. Actual and potential drug interactions of psychotropic drugs in their clinical evidence dimension in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 4. Actual and potential drug interactions of psychotropic drugs in their manifestation dimension in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 5. Actual and potential drug-drug interactions of psychotropic drugs in their time-of-onset dimension in patients of the COVID-19 Medicine Department of the Villa El Salvador Emergency Hospital.

Table 6. Actual and potential drug interactions of psychotropic drugs in their causality algorithm dimension in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 7. Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital according to sex.

Table 8. Actual and potential drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital according to age.

Table 9. Psychotropic drugs with the highest frequency of actual and potential drug-drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 10. Psychotropic drugs with the highest frequency of actual and potential drug-drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Table 11. Description of actual drug-drug interactions of psychotropic drugs in patients of the COVID-19 Medicine Service of the Villa El Salvador Emergency Hospital.

Discussion and conclusion

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