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Roy S, Charreteur R, Peries M, Kheloufi F, Eiden C, Nagot N, Donnadieu-Rigole H, Micallef J, Peyrière H. Abuse and misuse of second-generation antipsychotics: an analysis using VigiBase TM , the World Health Organisation pharmacovigilance database. Br J Clin Pharmacol 2022; 88:4646-4653. [PMID: 35633029 DOI: 10.1111/bcp.15420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
The study aim was to assess the abuse/misuse potential of second-generation antipsychotics (SGAPs) using VigiBaseTM data. We extracted individual case safety reports (ICSRs) of 'Drug abuse, dependence, and withdrawal' involving SGAPs up to June 2018. We assessed disproportionate reporting by calculating the Information Component (IC), considering the lower end of the 95% credibility interval for IC (IC025 ), and the Proportional Reporting Ratio (PRR). We identified 1,683 ICSRs recorded as 'abuse, dependence, and withdrawal' involving SGAPs, mainly quetiapine (n=1,089) and olanzapine (n=209). The disproportional reporting indicators highlighted an association between 'Drug abuse and dependence', and quetiapine, olanzapine, and ziprasidone, as indicated by the IC025 (2.263, 0.259, and 1.051, respectively) and PRR values (3.929, 1.020, and 1.334, respectively). The abuse/misuse potential is confirmed for quetiapine and olanzapine and highlighted for the first time for ziprasidone. Physicians should consider these risks when prescribing these antipsychotics, especially to patients with history of drug abuse.
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Affiliation(s)
- Sophie Roy
- Addictovigilance Centre, Montpellier University Hospital, Montpellier, France
| | - Robin Charreteur
- Addictovigilance Centre, Montpellier University Hospital, Montpellier, France
| | - Marianne Peries
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier, France
| | - Farid Kheloufi
- Addictovigilance Centre, Department of Clinical Pharmacology and Pharmacovigilance, University of Aix Marseille, INSERM UMR 1106 Institut de Neurosciences des Systèmes, Marseille, France
| | - Céline Eiden
- Addictovigilance Centre, Montpellier University Hospital, Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier, France
| | - Hélène Donnadieu-Rigole
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier, France.,Department of Addictology, Montpellier University Hospital, Montpellier, France
| | - Joëlle Micallef
- Addictovigilance Centre, Department of Clinical Pharmacology and Pharmacovigilance, University of Aix Marseille, INSERM UMR 1106 Institut de Neurosciences des Systèmes, Marseille, France
| | - Hélène Peyrière
- Addictovigilance Centre, Montpellier University Hospital, Montpellier, France.,Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier, France
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Abstract
Ziprasidone is an atypical antipsychotic approved for the treatment of schizophrenia and bipolar mania in adults and is used off label in children and adolescents. Despite increasing use of ziprasidone in both adult and pediatric populations, there remains a paucity of reports describing unintentional pediatric exposures. The following report describes a patient with isolated ziprasidone ingestion who required intubation secondary to respiratory failure. A 15-month-old previously healthy boy presented to the emergency department shortly after his father found him with approximately five partially dissolved 80-mg ziprasidone tablets in his mouth. The child was flaccid and lethargic with no eye opening, withdrawing from pain only. Two hours after arrival, he developed worsening CNS depression with inability to protect his airway and underwent endotracheal intubation. A serum ziprasidone level was 330 ng/mL by LC/MS. The patient was extubated approximately 14 h later and was discharged from the hospital shortly thereafter in good health without neurological sequelae. Isolated pediatric ingestion of ziprasidone resulting in the need for significant medical intervention has not been previously reported. We report a case of respiratory failure requiring intubation following accidental ziprasidone ingestion with confirmatory serum levels.
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Affiliation(s)
- Chip Gresham
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA.
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