Psychiatric patients are high-risk patients for the development of pharmacokinetic drug–drug interactions (DDIs), leading to highly variable (victim) drug serum concentrations. Avoiding and targeting high-risk drug combinations could reduce preventable adverse drug reactions (ADRs). Pharmacokinetic cytochrome P450 (CYP)-mediated DDIs are often predictable and, therefore, preventable. The retrospective, longitudinal analysis used informations from a large pharmacovigilance study (Optimization of pharmacological treatment in hospitalized psychiatric patients study, study number 01VSF16009, 01/2017), conducted in 10 psychiatric hospitals in Germany. Medication data were examined for the co-prescription of clinically relevant CYP inhibitors or inducers and substrates of these enzymes (victim drugs). In total, data from 27,396 patient cases (45.6% female) with a mean (mean ± standard deviation (SD)) age of 47.3 ± 18.3 years were available for analysis. CYP inhibitors or inducers were at least once prescribed in 14.4% (n = 3946) of the cases. The most frequently prescribed CYP inhibitors were melperone (n = 2504, 28.1%) and duloxetine (n = 1324, 14.9%). Overall, 51.0% of the cases taking melperone were combined with a victim drug (n = 1288). Carbamazepine was the most frequently prescribed CYP inducer (n = 733, 88.8%). Combinations with victim drugs were detected for 58% (n = 427) of cases on medication with carbamazepine. Finally, a DDI was detected in 43.6% of the cases in which a CYP inhibitor or inducer was prescribed. The frequency of CYP-mediated DDI is considerably high in the psychiatric setting. Physicians should be aware of the CYP inhibitory and inducing potential of psychotropic and internistic drugs (especially, melperone).

精神病患者是发生药代动力学药物相互作用 (DDI) 的高危患者，导致药物血清浓度变化很大（受害者）。避免和针对高风险药物组合可以减少可预防的药物不良反应 (ADR)。药代动力学细胞色素 P450 (CYP) 介导的 DDI 通常是可预测的，因此是可以预防的。回顾性纵向分析使用了在德国 10 家精神病医院进行的大型药物警戒研究（住院精神病患者的药物治疗优化研究，研究编号 01VSF16009，01/2017）的信息。检查了临床相关 CYP 抑制剂或诱导剂和这些酶的底物（受害者药物）的共同处方的药物数据。总共有来自 27,396 例患者（45. 6% 女性）平均（平均值±标准差（SD））年龄为 47.3±18.3 岁可用于分析。至少有 14.4% 的患者使用过 CYP 抑制剂或诱导剂（n  = 3946) 个案例。最常用的 CYP 抑制剂是美哌酮 ( n  = 2504, 28.1%) 和度洛西汀 ( n  = 1324, 14.9%)。总体而言，服用美哌酮的病例中有 51.0% 与受害者药物结合使用 ( n  = 1288)。卡马西平是最常用的 CYP 诱导剂 ( n  = 733, 88.8%)。58% ( n = 427) 使用卡马西平药物治疗的病例。最后，在开具 CYP 抑制剂或诱导剂的病例中，有 43.6% 的病例检测到 DDI。在精神病学环境中，CYP 介导的 DDI 的频率相当高。医生应了解精神药物和内科药物（尤其是美哌酮）的 CYP 抑制和诱导潜力。