Analysis of prescriptions of three selective serotonin reuptake inhibitors from a perspective of metabolic interactions

Objective: To find out the current status in clinical use of 3 selective serotonin reuptake inhibitors (SSRIs) and guide the clinicians to use them rationally. Methods: Using a pharmacy administration software, prescriptions containing fluoxetine, paroxetine and sertraline were investigated from a perspective of metabolic drug-drug interactions. Results: Compared with paroxetine or sertraline, the total number of prescriptions containing fluoxetine was greater. In fluoxetine concurrent therapy, 11 drugs have been documented to have clinically significant drug interactions with it. In paroxetine concurrent therapy, one drug has been documented to have clinically significant drug interactions with it. Six drugs had theoretically significant drug interactions with fluoxetine. There were 11 kinds of fluoxetine coadministration with 2 more drugs. Among these, each concurrent drug had either potentially or documented significant drug interaction with fluoxetine. Conclusion: Compared with paroxetine or sertraline, risk of drug interaction of fluoxetine concurrent therapy is greater. Paroxetine is an alternative when coadministration with CYP3A4 inhibitors/or substrates should be needed. For fluoxetine and paroxetine, dosage cutting is needed in case of coadministration with CYP2D6 substrates. Sertraline's coadministration is relatively safe, although interactions with CYP3A4 substrates are still warned. Pharmacists should enhance the awareness of censoring prescriptions and patient education in SSRIs concurrent therapy. Monitoring of blood concentrations of therapeutic drugs may be taken in case of suspected drug interactions.