Combination drug therapy in psychopharmacology

Intra-city differences in psychotropic drug use: a Nigerian scene

In a study of prescribing practice in 3 psychiatric institutions in Lagos, Nigeria, patterns of psychotropic drug use were generally unsatisfactory in terms of poly-pharmacy, high frequency of daily multiple administrations and prolonged use of minor tranquillisers. These deficiencies were noticeable in one of the hospitals that had the lowest doctor:patient ratio with consequent greatest workload, employed the 'medical model' as its main practice-orientation and that bore responsibility for a large part of community psychiatric morbidity. The widespread use of anti-parkinsonian agents had some rationality in view of the grossly inadequate community-based facilities needed to control drug induced extra-pyramidal side-effects. Improving psychiatric services, through personnel training, sufficient funding and the realisation of the need for therapists to conform to acceptable rules of drug prescribing, would help tremendously to minimise the vagaries and anomalies of drug use observed.

Drug-antacid interactions: assessment of clinical importance

Antacids and adsorbents are commonly used preparations that are generally considered to be pharmacologically inert and free from adverse effects. They may, however, interact with a diverse range of primary drugs and the sequelae can be disadvantageous to the efficacy of the primary medication. Many such reports in the literature are based on animal experiments, or on single-dose studies in healthy subjects. Some reports are anecdotal and are unconfirmed; others are based solely on in vitro evidence. Potentially important interactions have been suggested for a relatively small group of drugs: tetracyclines, phenytoin, digoxin, chloroquine, cimetidine, quinidine, nonsteroidal antiinflammatory drugs, and beta-blocking agents. The evidence for these has been critically evaluated, as well as for antacid-anticoagulant and antacid-nitrofurantoin interactions that have been wrongly emphasized in the literature. The majority of literature reports on interactions with antacids have been overemphasized; only ferrous sulfate-, isoniazid-, and tetracycline-antacid interactions fall into a category I importance (scale I-III of descending importance). This category is for those interactions with good evidence of actual or potential importance in patients or in relevant studies on normal subjects.

Polypharmacy among psychiatric patients

The purpose of the present study is to determine the frequency of polypharmacy among psychiatric patients in Helsinki, and to ascertain whether this practice is supported by clinical trials. The drugs prescribed in 1 day to a sample of patients (n = 694) in mental hospitals and outpatient clinics in Helsinki were studied. 69% of patients received more than on psychotropic drug in 1 day (61% received "proper" psychotropic drugs). On the average there were 2.1 different psychotropic drugs per patient, and the maximum was 6. A review of controlled clinical trials on the simultaneous use of more than one proper psychotropic drug in psychiatric diseases (excluding fixed combinations) revealed 14 trials. In only three trials was the combination better than its single components or placebo. Thus, there seems to be no evidence from clinical trials defending the frequent polypharmacy. A radical reduction in the number of psychotropic drugs prescribed for psychiatric patients is apparently desirable.