Perceptions and prescribing considerations among US psychiatrists regarding drug-drug interactions associated with oral atypical antipsychotics

Objective: Contemporary literature has demonstrated the potential for drug-drug interactions (DDIs) with oral atypical antipsychotic (OAA) agents. However, less is known about psychiatrists' perceptions about DDIs when prescribing OAAs. This study addresses this gap by surveying US psychiatrists about their perceptions of DDI when prescribing a new OAA. Methods: An online survey of 131 US psychiatrists was conducted to assess if considerations of DDIs were taken into account when prescribing a new OAA within their practice and prescribing patterns. For each survey question, results are presented as the proportion of psychiatrists in each rating category. Data were collected on physicians' awareness and concern about DDIs when prescribing OAAs, perception of frequency and severity of OAA-related DDIs, and methods of monitoring and preventing OAA-related DDIs. Results: Of the psychiatrists surveyed, 9.2% considered themselves well-informed (rating of 10/10) about OAA-related DDIs. In the 3-month period preceding the survey date, psychiatrists reported that on average 7.5 (SD 12.4) of their patients experienced a potentially OAA-related DDI event which represented an average of 2.5% (SD 4.8%) of their total number of patients. In all, 19.8% of the psychiatrists reported they were currently tracking the level of confirmed OAA-related DDI events in their practices; these psychiatrists reported a mean 21.1% incidence rate of confirmed DDI events experienced by patients starting a new OAA therapy in their practice. The psychiatrists ranked the risks of cardiovascular events and of neurological impairment as the two most frequent and severe potential DDI events to consider when prescribing a new OAA, in combination with selective serotonin reuptake inhibitors, mood stabilizers, and antihypertensive agents, the drugs most frequently associated with the most severe OAA-related DDIs. Conclusions: Psychiatrists, on recall of recent cases, perceive DDI events to be frequent in patients starting a new OAA therapy. While there appears to be some awareness of DDI-related issues among psychiatrists, this survey of psychiatrists perceptions suggests the need for systematic tracking of OAA-related DDI events and additional psychiatrist training on optimal OAA choice to prevent DDIs.