Psychotropic drug-induced adverse drug reactions in 462,661 psychiatric inpatients in relation to age: results from a German drug surveillance program from 1993-2016.

IF 3.6 3区 医学 Q1 PSYCHIATRY
Johanna Seifert, Matthias A Reinhard, Stefan Bleich, Andreas Erfurth, Waldemar Greil, Sermin Toto, Renate Grohmann, Catherine Glocker
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引用次数: 0

Abstract

Background: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs.

Methods: This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP) from 1993-2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns.

Results: The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92-1.05). However, older patients had a higher risk for delirium (2.35, 1.85-2.99), hyponatremia (3.74, 2.85-4.90), and orthostatic syncope (2.37, 1.72-3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45-2.48) and Pisa-/metronome syndrome (3.61, 2.51-5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10-0.37), akathisia (0.47, 0.29-0.76), liver dysfunction (0.63, 0.48-0.82), weight gain (0.07, 0.04-0.14), sexual dysfunction (0.03, CI 0.00-0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02-0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26-1.40)-especially selective serotonin reuptake inhibitors (1.57, 1.26-1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80-2.29)-and lithium (1.74, 1.52-2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71-0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07-1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22-1.34). ADRs in older patients were 6.4 times more likely to result in death.

Conclusions: Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered "safe".

462,661名精神病住院患者因精神药物引起的药物不良反应与年龄的关系:1993-2016年德国药物监测计划的结果。
背景:临床实践表明,老年人(即年龄≥ 65 岁)比年轻患者(即年龄≥ 65 岁)更容易发生药物不良反应(ADR):这项观察性研究利用德国药物警戒项目 "Arzneimittelsicherheit in der Psychiatrie"(AMSP)1993-2016年间的数据,调查了精神病住院患者中老年人(n = 99,099 人)和年轻人(n = 363,562 人)发生精神药物相关不良反应的风险。研究的目的是评估年龄是否会影响特定ADR类型的风险,以及某些精神药物是否会引起特别关注:老年患者和年轻患者的 ADR 风险没有差异(相对风险为 0.98,95% 置信区间为 0.92-1.05)。然而,老年患者发生谵妄(2.35,1.85-2.99)、低钠血症(3.74,2.85-4.90)和正压性晕厥(2.37,1.72-3.26)以及某些类型的 EPS(如帕金森氏症(1.89,1.45-2.48)和比萨/麦特隆综合征(3.61,2.51-5.18)的风险较高。老年患者发生急性肌张力障碍(0.20,0.10-0.37)、运动障碍(0.47,0.29-0.76)、肝功能异常(0.63,0.48-0.82)、体重增加(0.07,0.04-0.14)、性功能障碍(0.03,CI 0.00-0.25)和高催乳素血症/半乳症(0.05,0.02-0.17)等其他 ADR 的风险明显较低。接受任何类型抗抑郁药物(1.33,1.26-1.40)治疗的老年患者--尤其是选择性5-羟色胺再摄取抑制剂(1.57,1.26-1.40)和选择性5-羟色胺-去甲肾上腺素再摄取抑制剂(2.03,1.80-2.29)--以及锂(1.74,1.52-2.00)患者的ADR风险高于年轻患者。老年患者服用第二代抗精神病药物的 ADR 风险较低(0.74,0.71-0.77),服用低效第一代抗精神病药物的 ADR 风险较高(1.19,1.07-1.33)。老年患者服用多种药物的 ADR 风险更高(1.28,1.22-1.34)。老年患者发生 ADR 并导致死亡的几率是正常人的 6.4 倍:临床医生和药剂师应了解各年龄组的 ADR 类型和高风险药物,并提供适当的监测。药物警戒对所有年龄段的精神病患者都至关重要,即使是被普遍认为 "安全 "的药物也不应忽视。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.60
自引率
2.70%
发文量
43
审稿时长
>12 weeks
期刊介绍: Annals of General Psychiatry considers manuscripts on all aspects of psychiatry, including neuroscience and psychological medicine. Both basic and clinical neuroscience contributions are encouraged. Annals of General Psychiatry emphasizes a biopsychosocial approach to illness and health and strongly supports and follows the principles of evidence-based medicine. As an open access journal, Annals of General Psychiatry facilitates the worldwide distribution of high quality psychiatry and mental health research. The journal considers submissions on a wide range of topics including, but not limited to, psychopharmacology, forensic psychiatry, psychotic disorders, psychiatric genetics, and mood and anxiety disorders.
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