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Table 4 Classification of first ranked psychotropic drug interactions, the two most frequent psychotropics involved and mechanism of interaction in 2000, and 2016, among patients in three nursing homes with 386 and 416 patients the respective years

From: A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators

  2000 2016   2000 2016
Patients n (%) Patients n (%) p-value First (%) Second (%) Mechanism First (%) Second (%) Mechanism
Interactions 63 (100.0) 146 (100.0) < 0.001
Pharmacodynamic 44 (69.8) 135 (92.5)   Citalopram (50.0) Risperidone (22.7) Priapism/QT-prolongationc Mirtazapine (43.2) Oxazapem (34.2) Sedationt
Pharmacokinetic 19 (30.2) 11 (7.5) Carbamazepine (42.1) Risperidone (21.1) Risperidone reduceds Valproic acid (45.5) Carbamazepine (36.4) CBZ-metabolite increaseds
Recommended action 0.006  
 Avoid 7 (11.1) 5 (3.4)   Levomepromazine (71.4) Haloperidol (57.1) QT-prolongationt Haloperidol (80.0) Citalopram (80.0) QT-prolongationt
 Monitor or adjust dose 21 (33.3) 79 (54.1) Carbamazepine (28.6) Olanzapine (19.0) Olanzapine reduceds Mirtazapine (77.2) Oxazepam (36.7) Sedationt
 Informative 35 (55.6) 62 (42.5) Citalopram (51.4) Risperidone (34.3) Priapism/QT-prolongationc Escitalopram (43.5) Oxazepam (38.7) Sedationt
Documentation 0.001  
 Study 13 (20.7) 11 (7.5)   Carbamazepine (46.2) Nortriptyline (23.1) Nortriptyline reduced Mirtazapine (54.5) Diazepam (45.5) CNS depression
 Case 14 (22.2) 15 (10.3)   Risperidone (57.1) Citalopram (50.0) Priapism/QT-prolongation Mirtazapine (40.0) Olanzapine (40.0) Sedation
 Theoretical 36 (57.1) 120 (82.2)   Citalopram (38.9) Levomepromazine (19.4) QT-prolongation Mirtazapine (44.2) Oxazepam (40.0) Sedation
Severity 0.222  
 Severe 35 (55.5) 64 (43.8)   Citalopram (42.9) Risperidone (40.0) Priapism/QT-prolongationc Mirtazapine (43.8) Escitalopram (37.5) Serotonine syndromet
 Moderate 27 (42.9) 81 (55.5) Citalopram (25.9) Zopiclone (22.2) Sedationt Oxazepam (60.5) Mirtazapine (45.7) Sedationt
 Mild 1 (1.6) 1 (0.7) Zopiclone (100.0) Carbamazepine (100.0) Sedationt Zopiclone (100.0) Carbamazepine (100.0) Sedationt
  1. Chi-square or Fischer’s exact test was used for comparison of proportions. c; Case, s; Study, t; Theoretical. Levomepromazine and nortiptyline are PIPS; potentially inappropriate psychotropic substances. Combination of levomepromazine and haloperdiol, and combination of mirtazapine and escitalopram, are both PICP. Notice that patients can have several concurrent psychotropic drug interactions. CBZ; carbamazepine