Contraindicated and serious outcomes in potential drug interactions present in Psychosocial Care Centers medical prescriptions
DOI:
https://doi.org/10.21527/2176-7114.2026.51.16851Keywords:
drug interaction, mental disorder, psychotropic drugs, drugs of abuseAbstract
To evaluate potential drug interactions in medical prescriptions issued at Psychosocial Care Centers. A retrospective, descriptive, documentary, and exploratory cross-sectional study with a quantitative approach, involving one hundred and seventy users from two psychosocial care services, all of whom were continuously using multiple medications. Prescriptions were analyzed to identify potential drug interactions. In all prescriptions evaluated, at least one potentially serious or contraindicated interaction was observed. The most commonly prescribed medications in these services included carbamazepine, sertraline, promethazine, diazepam, clonazepam, haloperidol, levomepromazine, and valproic acid. The frequent use of antipsychotics, anticonvulsants, and antidepressants was associated with an increased risk of clinically significant drug interactions. It is concluded that the use of multiple medications in the treatment of mental disorders is an established clinical practice; however, it is associated with elevated risks. The complex profile of patients receiving care requires an individualized therapeutic approach, taking into account comorbidities, socioeconomic vulnerability, treatment resistance, symptom diversity, potential adverse effects, and drug interactions with other medications and other substances.
References
1. Silva AO, Barbosa AA, Cunha APS, Rolim IA A, Santos RF, Borges JMP, Lemos GS. Potential interactions between drugs and alcohol-medications in alcoholic patients treated by a Psychosocial Alcohol and Drug Care Center. RSD [Internet]. 2021;10(9):e20610917697.
2. Sun L, Mi K, Hou Y, Hui T, Zhang L, Tao Y, Liu Z, Huang L. Pharmacokinetic and pharmacodynamic drug-drug interactions: research methods and applications. Metabolites. 2023;13(8):897.
3. Cruz LO, Dolabela MF. Drug treatment of patients with schizophrenia: adherence, drug interactions and adverse reactions. RSD [Internet]. 2021;10(3):e2010313087.
4. Silva WLF, Gomes LC, Silvério MS, Cruz DT. Factors associated with non-adherence to pharmacotherapy in older people in primary health care in Brazil: a systematic review. Rev. Bras. Geriatr. Gerontol. 2021;24(4):e210156.
5. Andrade GB, Andrade TB, Silva JN. Indiscriminate use of non-steroidal anti-inflammatory drugs by the elderly. Rev Cient Fac Educ e Meio Ambient [Internet]. 2022;13(1):59-76.
6. Sousa APR, Melo TS, Linhares MI, Mormino KBNT. The impact of drug interactions in a hospital environment and the role of clinical pharmaceuticals in this scenario: a literature review. Saúde (Sta. Maria) [Internet]. 2023;49(2):e64854.
7. ICD-11: International Statistical Classification of Diseases and Related Health Problems. OMS. 2022. [Acesso em: 15 Dez. 2024]. Disponível em: https://www.who.int/classifications/ classification-of-diseases.4 de jan. de 2022
8. Merative. Micromedex drug interactions. USMerative, 2022. [Acesso em: 15 Dez. 2024]. Disponível em: https://www.micromedexsolutions.com/home/dispatch
9. Drugsite Trust. Drugs.com. New Zealand, 4 jan. 2024. [Acesso em: 15 Dez. 2024]. Disponível em: https://www.drugs.com/support/about.html
10. Almeida FM, Souza MKS, Souza LM, Valença DF, Alves MS, Santos AC, Brito GC, Di Pietro G. Sociodemographic and pharmacotherapeutic profile of Psychosocial Care Centers III Alcohol and Drugs users. SMAD, Rev Eletrônica Saúde Mental Álcool Drog [Internet]. 2023;19(2):95-107.
11. Santos NM, Nascimento MRS, Paulo MF, Silva RCM, Diniz LPM, Fernandes FECV. Profile of users of a Psychosocial Center AD III in the Vale do São Francisco’ Sertão. Revista Amazonia Sci Health. 2024,12(2):97-108.
12. Akour A, Halloush S, Nusair MB, Barakat M, Abdulla F, Al Momani M. Gaps in pharmaceutical care for patients with mental health issues: a cross-sectional study. Int J Clin Pharm. 2022;44(4):904-913.
13. Alves GA, Oliveira G, Fernandes IB, Lino MT, Castor NS, Martins FA, Ferreira PS. Perfil dos usuários do CAPS III de Várzea Grande. Informe Epidemiológico. 2024;13:1-8. ISSN:2966-2222
14. Oliveira EC, Pereira CC. Mental health in Brazil: associations between sociodemographic and behavioral variables. Braz. J. Hea. Rev. [Internet]. 2024;7(3):e69646.
15. Salomon T, Cremonte M, Conde K. Evidence of DSM-5 and ICD-11 concurrent validity among Argentineans seeking treatment for alcohol use disorders. Rev. Cient. Cienc. Salud. 2024;6:e6132.
16. McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, Vieta E, Vinberg M, Young AH, Mansur RB. Bipolar disorders. Lancet. 2020;396(10265):1841-1856.
17. Song S, Zilverstand A, Gui W, Pan X, Zhou X. Reducing craving and consumption in individuals with drug addiction, obesity or overeating through neuromodulation intervention: a systematic review and meta-analysis of its follow-up effects. Addiction. 2022;117(5):1242-1255.
18. Fluyau D, Kailasam VK, Pierre CG. Beyond benzodiazepines: a meta-analysis and narrative synthesis of the efficacy and safety of alternative options for alcohol withdrawal syndrome management. Eur J Clin Pharmacol. 2023;79(9):1147-1157.
19. Bahji A, Bach P, Danilewitz M, Crockford D, El-Guebaly N, Devoe DJ, Saitz R. Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: a systematic review and network meta-analysis. Addiction. 2022;117(10):2591-2601.
20. Andersen-Ranberg NC, Poulsen LM, Perner A, Wetterslev J, Estrup S, Hästbacka J, Morgan M, & AID-ICU Trial Group. Haloperidol for the treatment of delirium in ICU patients. N Engl J Med. 2022;387(26):2425-2435.
21. Ryan K, Benz P, Zosel A, Farkas A, Theobald J. QTc prolongation in poison center exposures to CredibleMeds list of substances with “known risk of torsades de pointes”. Cardiovasc Toxicol. 2022;22(9):866-877.
22. Lähteenvuo M, Tiihonen J. Antipsychotic Polypharmacy for the Management of Schizophrenia: Evidence and Recommendations. Drugs. 2021;81(11):1273-1284.
23. Dib JE, Yaacoub HE, Ikdais WH, Atallah E, Merheb TJ, Ajaltouni J, Akkari M, Mourad M, Nasr ME, Hachem D, Kazour F, Tahan F, Haddad G, Azar J, Zoghbi M, Haddad C, Hallit S, Adams CE. Rapid tranquillisation in a psychiatric emergency hospital in Lebanon: TREC-Lebanon - a pragmatic randomised controlled trial of intramuscular haloperidol and promethazine v. intramuscular haloperidol, promethazine and chlorpromazine. Psychol Med. 2022;52(13):2751-2759.
24. Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, Walaszek A, Buckley P, Lenzenweger MF, Young AS, Degenhardt A, Hong SH. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020;177(9):868-872.
25. Silva A, Figueiredo KA, Spindola DB. Psychotropic polypharmacy and the medicalization of life in a Psychosocial Care Center alcohol and other drugs in the Federal District. HRJ. 2023;4(19):78-89.
26. Bandeira VAC, Schneider A, Colet CF. Potential medicinal interactions in an adult Psychosocial Care Center. RIES [Internet]. 2024;12(1):1-10.
27. Zaccara G, Lattanzi S, Russo E. Pharmacokinetic drug interactions between antiseizure medications and drugs for comorbid diseases in children with epilepsy. Expert Opin Drug Metab Toxicol. 2021;17(5):595-610.
28. Stuhec M, Nemec A. Clinical pharmacist interventions on potentially inappropriate medications in older primary care patients with mental disorders with polypharmacy: retrospective cohort study. Psychiatry Clin Neurosci. 2023;77(1):64-65.
29. Prisco L, Sarwal A, Ganau M, Rubulotta F. Toxicology of Psychoactive Substances. Crit Care Clin. 2021;37(3):517-541.
30. Prakash S, Rathore C, Rana K, Patel H. Antiepileptic drugs and serotonin syndrome - A systematic review of case series and case reports. Seizure. 2021:91:117-131.
31. Santana GB, Kuriki TF, Soares LSML. Drug interactions in psychiatric patients: an integrative review. Braz. J. Develop. [Internet]. 2024;10(10):e73930.
32. Protti M, Mandrioli R, Marasca C, Cavalli A, Serretti A, Mercolini L. New-generation, non-SSRI antidepressants: drug-drug interactions and therapeutic drug monitoring. Part 2: NaSSAs, NRIs, SNDRIs, MASSAs, NDRIs, and others. Med Res Ver. 2020;40(5):1794-1832.
33. Fluyau D, Mitra P, Jain A, Kailasam VK, Pierre CG. Selective serotonin reuptake inhibitors in the treatment of depression, anxiety, and post-traumatic stress disorder in substance use disorders: a Bayesian meta-analysis. Eur J Clin Pharmacol. 2022;78(6):931-942.
34. Yang W, Jia YH, Jiang HY, Li AJ. Antidepressant use and the risk of seizure: a meta-analysis of observational studies. Eur J Clin Pharmacol. 2024;80(2):175-183.
35. Mota MCV, Santos RT, Sousa YMA. The role of pharmacists in guiding and impacting the misuse of over-the-counter medications in pharmacies. Braz. J. Implantol. Health Sci. [Internet]. 2024;6(11):566-83.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Fernanda Camargo Mendonça de Araújo, Joana Santos Sales, Camila Benetti, Deiziele Santana Alves, André Gustavo Carvalho de Oliveira, Giuliano Di Pietro
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
