Clomipramine therapy in the geriatric hospital: experience with therapeutic drug monitoring

Postdischarge adverse drug reactions in primary care originating from hospital care in France: a nationwide prospective study

OBJECTIVE

To describe and estimate the incidence and preventability of postdischarge adverse drug reactions (ADRs) detected in primary care in France.

DESIGN

Prospective study of patients referred to hospital by participating general practitioners (GPs). These GPs reported all cases of an adverse reaction to a drug instituted in hospital among patients who consulted them within 30 days of discharge.

SETTING

305 general practices from all French regions.

PATIENTS

7540 patients referred by GPs to private or public hospitals.

MAIN OUTCOME MEASURES

The incidence for postdischarge ADRs in primary care, and their preventability.

RESULTS

30 cases of postdischarge ADR were detected in 29 re-consulting patients, yielding a minimal incidence for France of 0.4 per 100 admissions (95% confidence interval 0.3 to 0.6). The ADRs were assessed as serious in 60% of cases. The main drug classes implicated were cardiovascular drugs (8 ADRs), oral anticoagulants (6), psychoactive drugs (4), antidiabetics (3), and opioid analgesics (3). Patients experiencing a postdischarge ADR were older than patients not experiencing one (median age: 77 vs 68 years; p = 0.004). Detected ADRs were considered preventable in 59% of cases.

CONCLUSIONS

Physicians and patients should be aware of the possible occurrence of postdischarge ADRs. Patient information in hospital, close postdischarge follow-up of patients at risk, and appropriate transmission of information between hospital physicians and GPs can help to prevent them.

The efficacy, safety and tolerability of antidepressants in late life depression: a meta-analysis

BACKGROUND

To determine the efficacy, safety and tolerability of antidepressants in depressed elderly patients.

METHODS

Search for randomized controlled double-blind studies evaluating atypical antidepressants (ATYPs), reversible inhibitors of monoamine oxidase-A, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants in moderate/severe depressed patients > or = 60 years for > or = four weeks. The random effects model (single-arm; comparative) was used to aggregate efficacy, safety and dropout.

RESULTS

No difference in single-arm aggregation of outcomes for four antidepressant classes. Comparative analyses showed no statistical difference between outcomes, except SSRIs had a higher response rate than ATYPs.

CONCLUSION

Elderly show no differences in antidepressant class outcomes.

LIMITATIONS

Heterogeneity and lack of power.

CLINICAL RELEVANCE

There is little advantage for antidepressant classes over another in the aged.