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Aakjær M, Werther SK, De Bruin ML, Andersen M. Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population-based cohort study in older adults. Clin Transl Sci 2022; 15:2105-2115. [PMID: 35733364 PMCID: PMC9468567 DOI: 10.1111/cts.13319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 01/25/2023] Open
Abstract
The selective serotonin reuptake inhibitors (SSRIs) citalopram and escitalopram are associated with QT prolongation, which increases the risk of serious arrhythmia. Consequently, regulatory agencies issued safety warnings in 2011. This study aimed to investigate the risk of serious arrhythmia following initiation of citalopram or escitalopram compared to other SSRIs and the risk in the periods before and after the warnings were issued. We conducted a series of nationwide cohort studies emulating a target trial using Danish healthcare register data from January 1, 2002, to December 31, 2016. We included patients (aged ≥65 years) who filled an SSRI prescription with a 1-year washout period before the index date. The outcome was an event of serious arrhythmia. Individuals were followed for a maximum of 6 months using an intention-to-treat approach. Log-binomial regression analyses were performed, estimating risk ratios (RRs) and 95% confidence intervals (CIs) adjusting for age and sex, comorbidities, and comedications with propensity scores. Dose-response effects were not investigated because dosage instructions were not available. We included 167,366 (146,014 individuals), 40,113 (37,069 individuals), and 50,281 (44,754 individuals) person-trials of citalopram, escitalopram, and other SSRIs, respectively. In total, there were 228 events of serious arrhythmia. No difference in risk was observed in the entire study period for either citalopram (0.87 [0.62-1.22]) or escitalopram (0.85 [0.53-1.40]). We identified lower point estimates after the safety warning, RR 0.54 (95% CI 0.31-0.93) for citalopram and 0.58 (0.20-1.63) for escitalopram. Initiation of citalopram and escitalopram was not associated with an increased risk of serious arrhythmia. However, lower point estimates were observed after the safety warning.
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Affiliation(s)
- Mia Aakjær
- Pharmacovigilance Research Center, Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
| | - Sarah Kimmer Werther
- Pharmacovigilance Research Center, Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), Department of PharmacyUniversity of CopenhagenCopenhagenDenmark,Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical PharmacologyUtrecht UniversityUtrechtThe Netherlands
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
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2
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Cao Y, Zhou M, Guo H, Zhu W. Associations of Antidepressants With Atrial Fibrillation and Ventricular Arrhythmias: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:840452. [PMID: 35402536 PMCID: PMC8990315 DOI: 10.3389/fcvm.2022.840452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Several published studies have disagreements on whether the use of antidepressants is associated with increased risk of arrhythmias. In this study, we performed this meta-analysis to assess the association of antidepressants with cardiac arrhythmias in patients who require antidepressants. Methods The PubMed and Embase databases were systematically searched until December 2021 to find studies that investigated the association between antidepressant use and cardiac arrhythmias. Studies that assessed the effects of any antidepressant on arrhythmias in patients who require antidepressants compared with those who require no antidepressants were included. We used a random-effects model to pool the adjusted risk ratios (RRs) and 95% confidence intervals (CIs). The stability of the results was examined by omitting an individual study at a time. Results A total of 3,396 studies were screened and 6 studies with 2,626,746 participants were finally included in this meta-analysis. When compared with no antidepressants, the use of antidepressants was significantly associated with an increased risk of atrial fibrillation (RR = 1.37, 95% CI: 1.16–1.61). However, there was no difference in the risk of ventricular arrhythmias or sudden cardiac death (RR = 1.33, 95% CI: 0.88–2.01) between the two studied groups. In the subgroup analysis, tricyclic antidepressants (RR = 1.12, 95% CI: 0.89–1.41), selective serotonin reuptake inhibitors (RR = 1.46, 95% CI: 0.63–3.38), and selective serotonin reuptake inhibitors (RR = 0.99, 95% CI: 0.97–1.01) did not increase the risk of ventricular arrhythmias and/or sudden cardiac death. Conclusion Recently published data suggested that the use of antidepressants did not increase the risk of ventricular arrhythmias or sudden cardiac death. Antidepressants were associated with an increased risk of atrial fibrillation but that still needs further confirmation.
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Affiliation(s)
- Yalin Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Mingyu Zhou
- Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Huaiyun Guo
- College of Pharmacy, Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wengen Zhu
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3
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Straley CM, Sochacki M, Reed E, Carr CN, Baugh TB. Comparison of the effect of citalopram, bupropion, sertraline, and tricyclic antidepressants on QTc: A cross-sectional study. J Affect Disord 2022; 296:476-484. [PMID: 34649181 DOI: 10.1016/j.jad.2021.08.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some data suggests that citalopram has more risk of corrected QT interval (QTc) prolongation than other selective serotonin reuptake inhibitors. Consequently the U.S. Food and Drug Administration distributed a safety warning limiting the maximum dose for citalopram. There is also a suggestion that bupropion may decrease QTc in patients on drugs that increase QTc. The goals of this cross-sectional study were to examine (1) effects on QTc of citalopram compared to sertraline, bupropion, and tricyclic antidepressants; (2) dose dependent effects of citalopram; and (3) effects of bupropion on citalopram-mediated changes in QTc. METHODS Records of subjects who received an EKG while taking one of the specified antidepressants were reviewed to collect demographic information, antidepressant history, and information about other confounders. Linear regression was used to examine the relationship between QTc and antidepressants. RESULTS 487 subjects provided 798 EKG records. The sample was 95% male with an average age of 61 years. No differences were found in QTc between citalopram and other antidepressants. No dose relationship was detected between citalopram and QTc. Bupropion did not affect the relationship between citalopram and QTc (coefficient = -3.4; 95%CI = -14.2, 7.5; p = 0.54). LIMITATIONS Observational study designs are prone to biases from retrospective data collection. Some data subsets had small numbers of subjects. CONCLUSIONS No effect of citalopram on QTc was found at therapeutic doses. Neither was there evidence of a "QTc-sparing" effect of bupropion. The risk of adverse cardiovascular effects from citalopram at doses of 60 mg per day or less appears minimal.
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Affiliation(s)
- Craig M Straley
- Pharmacy Department (119A), Battle Creek Veterans Affairs Medical Center, 5500 Armstrong Road, Battle Creek, MI, USA; College of Pharmacy, Ferris State University, Big Rapids, MI, USA.
| | - Marisa Sochacki
- Pharmacy Department (119A), Battle Creek Veterans Affairs Medical Center, 5500 Armstrong Road, Battle Creek, MI, USA
| | - Ellen Reed
- Pharmacy Department (119A), Battle Creek Veterans Affairs Medical Center, 5500 Armstrong Road, Battle Creek, MI, USA
| | - Chelsea N Carr
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Terrence Bradley Baugh
- Pharmacy Department (119A), Battle Creek Veterans Affairs Medical Center, 5500 Armstrong Road, Battle Creek, MI, USA
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Prasitlumkum N, Cheungpasitporn W, Tokavanich N, Ding KR, Kewcharoen J, Thongprayoon C, Kaewput W, Bathini T, Vallabhajosyula S, Chokesuwattanaskul R. Antidepressants and Risk of Sudden Cardiac Death: A Network Meta-Analysis and Systematic Review. Med Sci (Basel) 2021; 9:medsci9020026. [PMID: 33922524 PMCID: PMC8167667 DOI: 10.3390/medsci9020026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Antidepressants are one of the most prescribed medications, particularly for patients with mental disorders. Nevertheless, there are still limited data regarding the risk of ventricular arrhythmia (VA) and sudden cardiac death (SCD) associated with these medications. Thus, we performed systemic review and meta-analysis to characterize the risks of VA and SCD among patients who used common antidepressants. Methods: A literature search for studies that reported risk of ventricular arrhythmias and sudden cardiac death in antidepressant use from MEDLINE, EMBASE, and Cochrane Database from inception through September 2020. A random-effects model network meta-analysis model was used to analyze the relation between antidepressants and VA/SCD. Surface Under Cumulative Ranking Curve (SUCRA) was used to rank the treatment for each outcome. Results: The mean study sample size was 355,158 subjects. Tricyclic antidepressant (TCA) patients were the least likely to develop ventricular arrhythmia events/sudden cardiac deaths at OR 0.24, 0.028–1.2, OR 0.32 (95% CI 0.038–1.6) for serotonin and norepinephrine reuptake inhibitors (SNRI), and OR 0.36 (95% CI 0.043, 1.8) for selective serotonin reuptake inhibitors (SSRI), respectively. According to SUCRA analysis, TCA was on a higher rank compared to SNRI and SSRI considering the risk of VA/SCD. Conclusion: Our network meta-analysis demonstrated the low risk of VA/SCD among patients using antidepressants for SNRI, SSRI and especially, TCA. Despite the relatively lowest VA/SCD in TCA, drug efficacy and other adverse effects should be taken into account in patients with mental disorders.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA 92521, USA; (N.P.); (K.R.D.)
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, USA;
- Correspondence: (W.C.); (R.C.)
| | - Nithi Tokavanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand;
| | - Kimberly R. Ding
- Division of Cardiology, University of California Riverside, Riverside, CA 92521, USA; (N.P.); (K.R.D.)
| | - Jakrin Kewcharoen
- Department of Internal Medicine, University of Hawaii, Honolulu, HI 96822, USA;
| | | | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA;
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand;
- Correspondence: (W.C.); (R.C.)
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Quinolizidine alkaloids derivatives from Sophora alopecuroides Linn: Bioactivities, structure-activity relationships and preliminary molecular mechanisms. Eur J Med Chem 2019; 188:111972. [PMID: 31884408 DOI: 10.1016/j.ejmech.2019.111972] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/24/2019] [Accepted: 12/12/2019] [Indexed: 02/05/2023]
Abstract
Quinolizidine alkaloids, as essential active ingredients extracted from Sophora alopecuroides Linn, have been well concerned in the past several decades owing to the unique structural features and numerous pharmacological activities. Quinolizidine alkaloids consist of matrine, oxymatrine, sophoridine, sophocarpine and aloperine etc. Additionally, quinolizidine alkaloids exert various excellent activities, including anti-cancer, anti-inflammation, anti-fibrosis, anti-virus and anti-arrhythmia regulations. In this review, we comprehensively clarify the pharmacological activities of quinolizidine alkaloids, as well as the relationship between biological function and structure-activity of substituted quinolizidine alkaloids. We believe that biological agents based on the pharmacological functions of quinolizidine alkaloids could be well applied in clinical practice.
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6
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Wu WT, Tsai CT, Chou YC, Ku PM, Chen YC, You SL, Hung CF, Sun CA. Cardiovascular Outcomes Associated With Clinical Use of Citalopram and Omeprazole: A Nationwide Population-Based Cohort Study. J Am Heart Assoc 2019; 8:e011607. [PMID: 31581860 PMCID: PMC6818043 DOI: 10.1161/jaha.118.011607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Recent studies have raised concerns about the reduced efficacy of citalopram when used concurrently with proton pump inhibitors. The aim of this study was to evaluate the associations between clinical use of citalopram and omeprazole and the risk of sudden cardiac arrest (SCA) in an Asian population. Methods and Results A retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study cohorts comprised 3882 patients with citalopram use alone, 31 090 patients with omeprazole use alone, and 405 patients with concomitant use of citalopram and omeprazole (as the exposed cohort), and 141 508 patients received treatment with antidepressants without the risk of SCA and/or proton pump inhibitors other than omeprazole (as the comparison cohort). The primary outcome was the occurrence of SCA. The hazard ratios and 95% CIs derived from the time-dependent Cox regression model were used to assess the association between the proposed drug treatments and risk of SCA. The adjusted hazard ratios of SCA was 1.32 (95% CI, 1.17-1.50) for citalopram use alone, 1.08 (95% CI, 0.98-1.20) for omeprazole use alone, and 2.23 (95% CI, 1.79-2.78) for concomitant use of citalopram and omeprazole. The cumulative incidence of SCA over the Kaplan-Meier curves was more pronounced in patients with concomitant use of citalopram and omeprazole than those treated with citalopram alone and omeprazole alone. Conclusions This cohort study demonstrated use of citalopram and omeprazole either in isolation use or in concomitant use to be at increased risk for SCA.
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Affiliation(s)
- Wen-Tung Wu
- Department of Pharmacy Practice Tri-Service General Hospital National Defense Medical Center Taipei Taiwan.,School of Public Health National Defense Medical Center Taipei Taiwan
| | - Chun-Teng Tsai
- School of Public Health National Defense Medical Center Taipei Taiwan
| | - Yu-Ching Chou
- School of Public Health National Defense Medical Center Taipei Taiwan
| | - Po-Ming Ku
- Department of Cardiology Chi-Mei Medical Center Tainan City Taiwan
| | - Yong-Chen Chen
- Department of Medicine College of Medicine Fu-Jen Catholic University New Taipei City Taiwan.,Big Data Research Center College of Medicine Fu-Jen Catholic University New Taipei City Taiwan
| | - San-Lin You
- Department of Medicine College of Medicine Fu-Jen Catholic University New Taipei City Taiwan.,Big Data Research Center College of Medicine Fu-Jen Catholic University New Taipei City Taiwan
| | - Chi-Feng Hung
- Department of Medicine College of Medicine Fu-Jen Catholic University New Taipei City Taiwan.,Big Data Research Center College of Medicine Fu-Jen Catholic University New Taipei City Taiwan
| | - Chien-An Sun
- Big Data Research Center College of Medicine Fu-Jen Catholic University New Taipei City Taiwan.,Department of Public Health College of Medicine Fu-Jen Catholic University New Taipei City Taiwan
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7
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Almuwaqqat Z, Jokhadar M, Norby FL, Lutsey PL, O'Neal WT, Seyerle A, Soliman EZ, Chen LY, Bremner JD, Vaccarino V, Shah AJ, Alonso A. Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the ARIC Study. J Am Heart Assoc 2019; 8:e012503. [PMID: 31140335 PMCID: PMC6585369 DOI: 10.1161/jaha.119.012503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The association of antidepressant medication type with the risk of cardiovascular disease (CVD) is unclear. We hypothesized that selective serotonin reuptake inhibitors (SSRIs) are associated with lower risks of CVD events relative to tricyclics and other non‐SSRI antidepressants. Methods and Results We studied 2027 participants from the ARIC (Atherosclerosis Risk in Communities) study (mean age 63±10 years; 29% men; 78% white) treated with antidepressants at some time between 1987 and 2013. Antidepressant usage was confirmed by participants bringing pill bottles to study visits. CVD events in the study sample were identified, including atrial fibrillation, heart failure, myocardial infarction, and ischemic stroke. Hazard ratios were used to compare CVD events adjusted for sociodemographic and clinical risk factors in SSRIs users (47%) versus non‐SSRI users. Participants were followed from antidepressant initiation up to 2016 for a median of 13.5 years. We identified 332 atrial fibrillation, 365 heart failure, 174 myocardial infarction and 119 ischemic stroke events. CVD risk was similar for SSRIs and non‐SSRI antidepressant users (hazard ratio, 1.10; 95% CI, 0.86–1.41 for atrial fibrillation; hazard ratio, 0.98; 95% CI, 0.77–1.25 for heart failure; hazard ratio, 0.91; 95% CI, 0.64–1.29 for myocardial infarction; and hazard ratio, 1.07; 95% CI, 0.70–1.63 for ischemic stroke). Conclusions SSRI use was not associated with reduced risk of incident CVD compared with non‐SSRI antidepressant use. These results do not provide evidence supporting the use of SSRIs compared with tricyclics and other non‐SSRI antidepressants in relation to CVD risk.
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Affiliation(s)
- Zakaria Almuwaqqat
- 1 Department of Medicine Emory University School of Medicine Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Maan Jokhadar
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Faye L Norby
- 3 Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Pamela L Lutsey
- 3 Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Wesley T O'Neal
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Amanda Seyerle
- 8 Eshelman School of Pharmacy University of North Carolina Chapel Hill NC
| | - Elsayed Z Soliman
- 4 Department of Epidemiology and Prevention Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston-Salem NC
| | - Lin Y Chen
- 5 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - J Douglas Bremner
- 7 Department of Psychiatry & Behavioral Sciences Emory University School of Medicine Atlanta GA.,9 Atlanta VA Medical Center Decatur GA
| | - Viola Vaccarino
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,6 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Amit J Shah
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,6 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,9 Atlanta VA Medical Center Decatur GA
| | - Alvaro Alonso
- 6 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
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8
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Das B, Rawat VS, Ramasubbu SK, Kumar B. Frequency, characteristics and nature of risk factors associated with use of QT interval prolonging medications and related drug-drug interactions in a cohort of psychiatry patients. Therapie 2019; 74:599-609. [PMID: 31053339 DOI: 10.1016/j.therap.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/22/2019] [Accepted: 03/11/2019] [Indexed: 01/08/2023]
Abstract
Quite a number of antipsychotic and antidepressant drugs are known to cause significant QT-prolongation. Psychiatric patients constitute a population at notable risk of drug-induced QT-prolongation. The aims were to explore frequency of use of QTc-interval prolonging agents and QT-prolonging drug-drug interactions, and prevalence of risk factors for QTc-interval prolongation in patients reporting to psychiatry out-patient department (OPD) in a tertiary care hospital in India. This prospective cross-sectional study was carried out in the psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to September 30, 2018 using the relevant prescriptions (i.e., the OPD case record forms and treatment sheets). For each patient, the entire medication list was analyzed for the possibility of interactions, with particular attention on the high-risk QT prolonging ones. Arizona Center for Education and Research on Therapeutics (AZCERT) QT drug lists were used to classify TdP risks of psychotropic and other medications. One thousand three hundred twenty-six (1326) patients attending the psychiatry OPD during the study period were scrutinized. Seven hundred fifty-one 751 patients (56.6%) were males whereas 575 (43.4%) were females in our study. Of the 1326 patients, 636 patients (47.9%) were identified as receiving interacting medications with the ability to induce torsades de pointe (TdP). Nine hundred seventeen (917) interacting medication pairs with torsadogenic risk were encountered. The most frequently interacting medications were from antipsychotic (794), antidepressant (519), antimicrobial (84), proton pump inhibitor (80), anticonvulsant (66), and anti-nausea (25) therapeutic categories. As per AZCERT classification (CredibleMeds TdP risk-stratification lists), 597 (36.8%), 443 (27.3%) and 432 (26.7%) of the interacting medications were associated with known, possible, and conditional risk of TdP, respectively. Concurrent prescriptions of QT-prolonging drugs is frequent in psychiatry OPD setting. Appropriate precautions should be instituted to obviate undesirable outcomes arising out of these interactions. This highlights the pressing need for clear protocols & strategies for implementation to motivate careproviders with clarity in the context of drug use guidelines for rational and safe prescribing in psychiatry.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India.
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India
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Abstract
Tricyclic antidepressants are used to treat a variety of mental disorders, and are considered a common cause of fatal drug poisoning. This study reports a young woman with no history of cardiac diseases who presented to the emergency department with heart palpitation, weakness, and lethargy. After a short period of time, she became unconscious and experienced hypotension and refractory arrhythmia, finally being diagnosed with imipramine poisoning. Accurate history taking and the possible causes of these complications including cardio-toxic drug poisoning should be considered in such patients.
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Affiliation(s)
- Nahid Azdaki
- Cardiovascular Diseases Research Center, Department of Cardiology, School of Medicine, Birjand University of Medical Science, Birjand, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
- Rocky Mountain Poison and Drug Center, Denver, CO, USA.
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10
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Biffi A, Rea F, Scotti L, Mugelli A, Lucenteforte E, Bettiol A, Chinellato A, Onder G, Vitale C, Agabiti N, Trifirò G, Roberto G, Corrao G. Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy. Eur J Clin Pharmacol 2017; 74:119-129. [PMID: 29046942 DOI: 10.1007/s00228-017-2352-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events. METHODS The cohort was composed by 199,569 individuals aged ≥ 65 years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14 days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs. CONCLUSIONS Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.
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Affiliation(s)
- A Biffi
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - F Rea
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - L Scotti
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - A Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - E Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - A Bettiol
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.,Treviso Local Health Unit, Treviso, Italy
| | | | - G Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - N Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - G Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - G Roberto
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | - G Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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