Asian Journal of Medical Research and Case Reports

Background: Outside their classical use in psychiatric settings, psychotropic drugs have important indications in non-psychiatric settings, including the management of acute postoperative pain, situational preoperative anxiety, perioperative insomnia, neuropathies, postoperative delirium, and hyperemesis. The increasing clinical use of psychotropic drugs, sometimes off-label, for the treatment of different conditions in both surgical and medical wards highlights the need for close clinical monitoring of unjustified use, drug-drug interactions (DDIs), and adverse drug reactions (ADRs).

Objectives: The objective of the present study was to assess and compare patterns of psychotropic drug prescribing, co-existing drug-related problems (DRPs), including clinically significant DDIs, and documented ADRs among adult patients admitted to surgical and medical wards in a tertiary teaching hospital.

Methods: A prospective, cross-sectional, descriptive observational study was conducted over six months, from 1 October 2025 to 31 March 2026, at S.S. Institute of Medical Sciences and Research Centre (SSIMS & RC), Davanagere, Karnataka, India. Using consecutive sampling, 110 consecutive patients of both sexes, aged 18 years or older, who were admitted to medical (n = 27) or surgical (n = 83) wards and received at least one psychotropic drug for an established non-psychiatric indication were included. Patients' sociodemographic data, clinical diagnoses, and prescribed medications were recorded in a structured proforma. Identified DRPs were classified using the Hepler-Strand classification. Potential DDIs were identified and validated using Lexicomp Online and Medscape Reference, and their severity was assessed using both databases. ADR causality and the probable relationship with the suspected drug were assessed using the Naranjo Probability Scale. Chi-square or Fisher's exact tests, as appropriate, were performed in SPSS version 28.0 to compare the surgical and medical groups.

Results: Among the 110 inpatients, 73 (66.4%) were male and 37 (33.6%) were female; 51.9% were aged 31-56 years. Psychotropic drug use was higher in surgical wards (75.5%, n = 83) than in general medicine wards (24.5%, n = 27). Of 153 psychotropic drug orders, alprazolam was the most frequently prescribed (44.5%, n = 68), followed by pregabalin (22.3%, n = 34) and nortriptyline (19.6%, n = 30). Overall, 74 patients (67.3%) received psychotropic monotherapy and 36 (32.7%) received combination therapy. Among the 52 patients with documented comorbidities, hypertension was the most common (48.1%, n = 25). A total of 126 potential DDI events were identified, of which 96 (76.2%) were classified as major, mainly involving combinations associated with central nervous system depression. The most frequent pairs included alprazolam with tramadol (n = 34) and pregabalin with tramadol (n = 20). Six ADRs were documented: excessive sedation associated with alprazolam (n = 3), dizziness associated with pregabalin (n = 1), and anticholinergic effects of nortriptyline, comprising dry mouth (xerostomia; n = 1) and constipation (n = 1). Causality was classified as probable in 50.0% and possible in 50.0% of ADRs.

Conclusion: Psychotropic drugs were commonly used in non-psychiatric inpatient care, with short-acting benzodiazepines used more frequently in surgical wards for perioperative anxiety and sedation, whereas neuromodulating drugs were used in medical wards for neuropathic pain. The high frequency of potentially major DDIs and the documented ADRs indicates the need for department-specific rational-prescribing guidance, standardised medication reconciliation, and direct ward-based involvement of clinical pharmacists.