目的 分析蚌埠市第一人民医院精神卫生科米氮平门诊处方中药物相互作用情况，促进合理用药。方法 采用回顾性研究，从信息化系统获取2022年1月1日—2023年6月30日米氮平联合用药门诊处方，分别基于Lexicomp、Medscape数据库识别药物相互作用，按新划分药物相互作用严重程度分级合并Lexicomp和Medscape数据库结果。描述性统计米氮平相关药物相互作用的发生率，以Kappa检验比较Lexicomp、Medscape、Lexicomp＋Medscape数据库中药物相互作用严重程度分级、风险点的一致性强度。结果 按纳排标准得到有效处方402张，按Lexicomp、Medscape、Lexicomp＋Medscape数据库，药物相互作用处方分别为402张（100%）、383张（95.3%）、402张（100%）。在严重程度分级、风险点方面，Lexicomp＋Medscape数据库与Lexicomp数据库的一致性很强（Kappa＞0.99，P＝0），而Lexicomp＋Medscape数据库或Lexicomp数据库与Medscape数据库有明显差异（Kappa＜0，P＜0.05）；Medscape、Lexicomp数据库在风险点方面有互补性。按药品计，Lexicomp＋Medscape数据库620例次药物相互作用中，米氮平与丁螺环酮、抗抑郁药帕罗西汀等的严重药物相互作用（5-HT综合征）达39.2%，应避免联用；与镇静催眠药、抗精神分裂症药的药物相互作用均为中度，达60.8%，应密切监测或换药。结论 蚌埠市第一人民医院米氮平与其他药物存在严重、中度药物相互作用，有必要结合Lexicomp＋Medscape数据库，加强米氮平药物相互作用要点培训，采取信息化管控，防范风险。

Objective To analyze drug interactions in the outpatient prescription of mirtazapine in the department of Mental Health, Bengbu First People’s Hospital, and to promote the rational use of medication. Methods A retrospective study was conducted to obtain the outpatient prescriptions for mirtazapine co-administration in the department from January 1, 2022 to June 30, 2023 from the information system, drug interactions were identified based on Lexicomp and Medscape database, respectively, and merged according to the newly classified drug interactions severity grading. The incidence of mirtazapine-associated drug interactions was descriptive statisticed, the strength of concordance of the severity grading of drug interactions and the risk points between and among the Lexicomp, Medscape, and Lexicomp + Medscape database were tested by Kappa test. Results A total of 402 effective prescriptions were obtained according to the allotting standard, and the drug interactions prescriptions were 402 (100%), 383 (95.3%) and 402 (100%) according to Lexicomp, Medscape, and Lexicomp + Medscape database, respectively. In terms of severity classification and risk points, Lexicomp + Medscape database and Lexicomp database were strongly consistent (Kappa > 0.99, P = 0), while Lexicomp + Medscape database or Lexicomp and Medscape database were significantly different (Kappa < 0, P < 0.05). Lexicomp and Medscape database are complementary in terms of risk points. In the 620 cases of Lexicomp + Medscape database drug interactions, miltazapine, buspirone, paroxetine, and other antidepressants had severe drug interactions (5-HT syndrome) of 39.2%, which should be avoided. Drug interactions with sedative hypnotics and antischizophrenic drugs were moderate, up to 60.8%, and should be closely monitored or changed. Conclusion There are severe and moderate drug interactions between mirtazapine and other drugs in Bengbu First People’s Hospital, and it’s necessary to strengthen the training on the essentials of mirtazapine drug interactions based on the Lexicomp + Medscape database, and to adopt informational controls to prevent risks.

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