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Ding J, Yang L, Cui X, Li L, Liu J, Sun H, Wang T, Zhang Y. A 5-year retrospective study of amisulpride steady-state plasma concentration in patients with schizophrenia in real-life settings based on therapeutic drug monitoring data. Asian J Psychiatr 2023; 87:103699. [PMID: 37481912 DOI: 10.1016/j.ajp.2023.103699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Here, we present a retrospective analysis of the last 5 years' data collected in real-life settings as direct evidence to evaluate the optimal therapeutic window of amisulpride (AMI) for psychiatric patients. METHODS Retrospective analysis of the therapeutic drug monitoring (TDM) results of AMI in outpatients and inpatients were obtained from the Xi'an Mental Health Center from 2017 to 2021. RESULTS The interquartile (P25-P75) AMI concentrations ranged 212.20-574.25 ng/mL. The results showed that the proportion of outpatients who received TDM once was significantly higher than that of inpatients who received TDM once (P < 0.001), whereas the reverse was true for those who experienced TDM more than twice (P < 0.001). Higher estimated plasma concentrations were identified in inpatients, female patients, and patients over 59 years of age. Nearly 57.21% of the samples had high concentrations (>320 ng/mL). CONCLUSIONS The optimal therapeutic reference range for AMI may require reconstruction to guide the use of AMI for the treatment of schizophrenia.
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Affiliation(s)
- Jing Ding
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Liu Yang
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Xiaohua Cui
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Luyao Li
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Jiarui Liu
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Hongrui Sun
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Ting Wang
- Xi'an Mental Health Center, 710100 Xi'an, PR China
| | - Yan Zhang
- Xi'an Mental Health Center, 710100 Xi'an, PR China.
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2
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Junqueira DR, Bennett D, Huh SY, Casañas I Comabella C. Clinical Presentations of Drug-Induced Hyperprolactinaemia: A Literature Review. Pharmaceut Med 2023; 37:153-166. [PMID: 36800148 PMCID: PMC10097739 DOI: 10.1007/s40290-023-00462-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/18/2023]
Abstract
Screening for drug-induced hyperprolactinaemia, a condition characterised by higher-than-normal levels of serum prolactin induced by drug treatments, requires a comprehensive understanding of the clinical presentations and long-term complications of the condition. Using two databases, Embase and MEDLINE, we summarised the available evidence on the clinical presentations and long-term complications of drug-induced hyperprolactinaemia. Clinical and observational studies reporting on drug treatments known or suspected to induce hyperprolactinaemia were included. Database searches were limited to the English language; no date or geographic restrictions were applied. Fifty studies were identified for inclusion, comprising a variety of study designs and patient populations. Most data were reported in patients treated with antipsychotics, but symptoms were also described among patients receiving other drugs, such as prokinetic drugs and antidepressants. Notably, the diagnosis of drug-induced hyperprolactinaemia varied across studies since a standard definition of elevated prolactin levels was not consistently applied. Frequent clinical presentations of hyperprolactinaemia were menstrual cycle bleeding, breast or lactation disorders, and sexual dysfunctions, described in 80% (40/50), 74% (37/50), and 42% (21/50) of the included studies, respectively. In the few studies reporting such symptoms, the prevalence of vaginal dryness impacted up to 53% of females, and infertility in both sexes ranged from 15 to 31%. Clinicians should be aware of these symptoms related to drug-induced hyperprolactinaemia when treating patients with drugs that can alter prolactin levels. Future research should explore the long-term complications of drug-induced hyperprolactinaemia and apply accepted thresholds of elevated prolactin levels (i.e., 20 ng/mL for males and 25 ng/mL for females) to diagnose hyperprolactinaemia as a drug-induced adverse event.Trial Registration PROSPERO International Prospective Register Of Systematic Reviews (CRD42021245259).
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Affiliation(s)
| | - Dimitri Bennett
- Takeda Development Center Americas, Inc., Cambridge, MA, USA. .,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Susanna Y Huh
- Takeda Development Center Americas, Inc., Cambridge, MA, USA.,Ironwood Pharmaceuticals, Boston, MA, USA
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3
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Amisulpride steady-state plasma concentration and adverse reactions in patients with schizophrenia: a study based on therapeutic drug monitoring data. Int Clin Psychopharmacol 2022; 37:255-262. [PMID: 35779068 DOI: 10.1097/yic.0000000000000420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of the study was to evaluate the reference range of amisulpride for Chinese patients with schizophrenia and to assess its possible influencing factors based on therapeutic drug monitoring information. The relative adverse reactions of patients induced by amisulpride were also systematically investigated. A total of 425 patients with schizophrenia were assessed, including Positive and Negative Syndrome Scales, Treatment Emergent Symptom Scale, blood routine examination, hepatorenal function, lipids, hormones, as well as myocardial enzymes at baseline, and following treatment with amisulpride for 8 weeks. The steady-state plasma concentration of amisulpride was assayed using two-dimensional liquid chromatography. At the same dose, the amisulpride plasma concentration of patients combined with clozapine was higher than that without clozapine. The therapeutic reference range of amisulpride can be defined as 230.3-527.1 ng/ml for Chinese patients with schizophrenia. The potential side effects appear to be associated with significantly increased levels of LDH, CK, creatine kinase isoenzyme (CK-MB), TC and decreased level of E 2 , relative to the amisulpride plasma concentration. These findings could provide individualized medication and reduce the adverse effects of amisulpride for Chinese patients with schizophrenia.
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4
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Pandit R, Cianci D, ter Hark SE, Winter‐van Rossum I, Ebdrup BH, Broberg BV, Garcia‐Portilla MP, Bobes J, Vinkers CH, Kahn RS, Guloksuz S, Huitema ADR, Luykx JJ. Phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients (from the OPTiMiSE cohort). Acta Psychiatr Scand 2019; 140:283-290. [PMID: 31323113 PMCID: PMC6771865 DOI: 10.1111/acps.13074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients. METHOD Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes. RESULTS Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (β = 0.94, P = 0.016), younger age (β = -0.07, P = 0.031) and absence of current comorbid major depression disorder (β = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG. CONCLUSIONS Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.
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Affiliation(s)
- R. Pandit
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - D. Cianci
- Department of Biostatistics and Research SupportJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUniversity of UtrechtUtrechtthe Netherlands
| | - S. E. ter Hark
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - I. Winter‐van Rossum
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - B. H. Ebdrup
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - B. V. Broberg
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark
| | - M. P. Garcia‐Portilla
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - J. Bobes
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - C. H. Vinkers
- Department of PsychiatryAmsterdam UMC (location VUmc)Amsterdamthe Netherlands,Department of Anatomy and NeurosciencesAmsterdam UMC (location VUmc)Amsterdamthe Netherlands
| | - R. S. Kahn
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryIcahn School of MedicineMount SinaiNew YorkUSA
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental HealthNeuroscience Maastricht University Medical CenterMaastrichtthe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
| | - A. D. R. Huitema
- Department of Pharmacy PharmacologyThe Netherlands Cancer InstituteAmsterdamthe Netherlands,Department of Clinical PharmacyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,GGNet Mental HealthApeldoornthe Netherlands
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5
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Täubel J, Ferber G, Fox G, Fernandes S, Lorch U, Camm AJ. Thorough QT study of the effect of intravenous amisulpride on QTc interval in Caucasian and Japanese healthy subjects. Br J Clin Pharmacol 2016; 83:339-348. [PMID: 27618796 PMCID: PMC5237697 DOI: 10.1111/bcp.13128] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/22/2016] [Accepted: 09/11/2016] [Indexed: 11/30/2022] Open
Abstract
AIM The D2 /D3 antagonist amisulpride has shown promising efficacy against postoperative nausea and vomiting (PONV) at low doses. We investigated whether intravenous amisulpride has an effect on the QTc interval in a formal Thorough QT study (TQT). METHODS This was a randomized, double-blind, placebo and positive-controlled, four-way crossover study. Forty healthy Caucasian and Japanese subjects were included to receive a single administration of 5 mg and 40 mg of i.v. amisulpride or a single oral dose of moxifloxacin or placebo per period. RESULTS The therapeutic dose of 5 mg amisulpride was associated with a slight, transient increase in mean ΔΔQTcF, from 2.0 ms prior to dosing to a peak of 5 ms (90% CI: 2.8, 7.1 ms) at 8 min, decreasing to 2.1 ms at 30 min after dosing. The supra-therapeutic dose of 40 mg given at twice the infusion rate was associated with prolongation in ΔΔQTcF peaking at 23.4 ms (90% CI: 21.3, 25.5 ms) at the end of infusion (8 min), returning below 10 ms within 1.5 h. Assay sensitivity was confirmed; ΔΔQTcF had increased by 12.3 ms (90% CI 10.1, 14.6 ms) at 4 h post-dose. The PK-PD relationship revealed no differences between Caucasian and Japanese subjects (p-value > 0.5). CONCLUSIONS Amisulpride has a plasma concentration-dependent effect on the QTc interval. The proposed therapeutic dose for management of PONV does not lead to a prolongation of QTcF above the threshold of regulatory concern, while such effect could not be excluded for the supratherapeutic dose.
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Affiliation(s)
- Jörg Täubel
- Richmond Pharmacology Ltd., St George's University of London, Cranmer Terrace, London, UK.,Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Georg Ferber
- Statistik Georg Ferber GmbH, Cagliostrostrasse, Riehen, Switzerland
| | | | - Sara Fernandes
- Richmond Pharmacology Ltd., St George's University of London, Cranmer Terrace, London, UK
| | - Ulrike Lorch
- Richmond Pharmacology Ltd., St George's University of London, Cranmer Terrace, London, UK
| | - A John Camm
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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6
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Chen CY, Yeh YW, Kuo SC, Ho PS, Liang CS, Yen CH, Lu RB, Huang SY. Catechol-O-methyltransferase gene variants may associate with negative symptom response and plasma concentrations of prolactin in schizophrenia after amisulpride treatment. Psychoneuroendocrinology 2016; 65:67-75. [PMID: 26724569 DOI: 10.1016/j.psyneuen.2015.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 01/04/2023]
Abstract
Catechol-O-methyltransferase (COMT) enzyme is involved in the pathogenesis of psychotic symptoms and may be associated with a therapeutic response to antipsychotic drugs. The aim of this study was to examine the relationship between COMT variants, plasma prolactin level, and the therapeutic effectiveness of amisulpride treatment in patients with schizophrenia. A 12-week naturalistic study of amisulpride treatment was carried out in 185 Han Chinese patients with schizophrenia. The patients were screened for 14 single-nucleotide polymorphisms of the COMT gene. The Positive and Negative Syndrome Scale (PANSS) was used to assess the improvement of psychopathological symptoms from the baseline to the end point in each subject. For better presentation of time-course changes in response status, a mixed model for repeated-measures (MMRM) analysis of symptom improvement during the 12-week treatment period was conducted. The change in plasma prolactin level after amisulpride treatment was also examined (n=51). No significant differences in the genotype frequencies of the COMT variants investigated were observed between responders and non-responders. Moreover, an MMRM analysis of psychopathological symptom improvement during the 12-week treatment course showed that it depended significantly on COMT variants (rs4680, rs4633, and rs6267), particularly regarding changes in negative symptoms. The increase in plasma prolactin levels observed was influenced by the COMT rs4680 variant and was positively correlated with a reduction in PANSS negative scores. Our results suggest that variation of the COMT gene is associated with treatment response regarding negative symptoms and prolactin changes after amisulpride treatment in patients with schizophrenia.
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Affiliation(s)
- Chun-Yen Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Wei Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shin-Chang Kuo
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Shen Ho
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Che-Hung Yen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ru-Band Lu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - San-Yuan Huang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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7
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Avcil M, Kapçı M, Yavaşoğlu I, Kantekin B, Akpek M. Simultaneous Use of Intravenous Lipid Emulsion and Plasma Exchange Therapies in Multiple Drug Toxicity. Med Princ Pract 2016; 25:577-579. [PMID: 27548660 PMCID: PMC5588510 DOI: 10.1159/000449250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 08/14/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to highlight the use of combined intravenous lipid emulsion (ILE) and plasma exchange (PE) therapies in multidrug toxicity. CLINICAL PRESENTATION AND INTERVENTION A 45-year-old woman who attempted suicide by ingesting large quantities of amisulpride (28 g), diazepam (250 mg), valsartan (2,240 mg), aripiprazole (45 mg) and paliperidone (21 mg) was taken to the hospital of Adnan Menderes University School of Medicine. Upon arrival, she exhibited signs of cardiotoxicity and severe depression of the central nervous and respiratory systems. She was treated successfully with ILE for 4 h and PE therapy for 36 h, consecutively. She was discharged on the fourth day of hospitalization having fully recovered. CONCLUSION The patient was successfully treated with the combination of ILE and PE.
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Affiliation(s)
- Mucahit Avcil
- Department of Emergency Medicine, Adnan Menderes University Hospital, Aydın, Turkey
| | - Mucahit Kapçı
- Department of Emergency Medicine, Adnan Menderes University Hospital, Aydın, Turkey
| | - Irfan Yavaşoğlu
- Department of Hematology Medicine, Adnan Menderes University Hospital, Aydın, Turkey
| | - Burçak Kantekin
- Department of Emergency Medicine, Adnan Menderes University Hospital, Aydın, Turkey
| | - Mahmut Akpek
- Department of Cardiology, Adnan Menderes University Hospital, Aydın, Turkey
- *Mahmut Akpek, MD, Department of Cardiology, Adnan Menderes University Hospital, Museum Avenue, TR−−09100 Aydýn (Turkey), E-Mail
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8
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Deepak TS, Raveesh BN, Parashivamurthy BM, Kumar MSN, Majgi SM, Nagesh HN. Clinical Assessment of Weight Gain with Atypical Antipsychotics - Blonanserin vs Amisulpride. J Clin Diagn Res 2015; 9:FC07-10. [PMID: 26266134 PMCID: PMC4525523 DOI: 10.7860/jcdr/2015/13007.6066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/22/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atypical antipsychotics appear to have the greatest potential to induce weight gain. Antipsychotic-induced weight gain is the one of main cause of non-compliance and discontinuation of treatment, often resulting in the relapse of psychosis. OBJECTIVE To compare the weight gain between amisulpride and blonanserin treatment, in persons with psychosis. MATERIALS AND METHODS Fifty six subjects with psychosis attending psychiatry department at KR Hospital, Mysore were randomized into two equal groups. After obtaining informed consent, subjects of group I received amisulpride tablets 200 mg BD, and group II received blonanserin tablets 4 mg BD, for eight weeks. Body weight, Body Mass Index (BMI) and Waist Hip Ratio (WHR) were measured at baseline, 4 weeks and 8 weeks. RESULTS The mean weight gain with amisulpride at 4 weeks was 2.73 kg (5.21%) and at 8 weeks was 4.34 kg (8.28%) from the baseline. The mean weight gain with blonanserin at 4 weeks was 1.77 kg (3.46%) and at 8 weeks was 3.46 kg (6.75%) from the baseline. The mean BMI increase at 8 weeks with amisulpride was 1.66 ± 0.56 and with blonanserin was 1.34 ± 0.77. The mean WHR increase at 8 weeks with amisulpride was 0.036 ± 0.026 and with blonanserin was 0.029 ± 0.020. There was statistically significant increase in weight, BMI and WHR associated with both blonanserin and amisulpride at 8 weeks. But there was no statistically significant difference in those parameters between blonanserin and amisulpride, at eight weeks. CONCLUSION Even though there was no significant difference in the weight gain caused by blonanserin, in comparison with amisulpride, both these drugs individually caused significant weight gain at 8 weeks, which is in contrast with the earlier studies, which needs to be further evaluated.
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Affiliation(s)
- TS Deepak
- Postgraduate, Department of Pharmacology, MMC&RI, Mysore, India
| | - BN Raveesh
- Professor and Head, Department of Psychiatry, MMC&RI, Mysore, India
| | | | - MS Narendra Kumar
- Assistant Professor, Department of Psychiatry, MMC&RI, Mysore, India
| | | | - HN Nagesh
- Assistant Professor, Department of Pharmacology, MMC&RI, Mysore, India
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9
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Lin ST, Chen CC, Tsang HY, Lee CS, Yang P, Cheng KD, Li DJ, Wang CJ, Hsieh YC, Yang WC. Association Between Antipsychotic Use and Risk of Acute Myocardial Infarction. Circulation 2014; 130:235-43. [DOI: 10.1161/circulationaha.114.008779] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background—
Antipsychotic medications have been increasingly and more widely prescribed despite continued uncertainty about their association with the incidence of acute myocardial infarction (AMI).
Methods and Results—
We investigated the risk of AMI associated with antipsychotic treatment in 56 910 patients with schizophrenia, mood disorders, or dementia first hospitalized or visiting an emergency room for AMI in 1999 to 2009. A case-crossover design was used to compare the distributions of antipsychotic exposure for the same patient across 1 to 30 and 91 to 120 days just before the AMI event. Adjustments were made for comedications and outpatient visits. The adjusted odds ratio of AMI risk was 2.52 (95% confidence interval, 2.37–2.68) for any antipsychotics, 2.32 (95% confidence interval, 2.17–2.47) for first-generation antipsychotics, and 2.74 (95% confidence interval, 2.49–3.02) for second-generation antipsychotics. The risk significantly increased (
P
<0.001) with elevations in dosage and in short-term use (≤30 days). Male patients, elderly patients, and patients with dementia were at significantly increased risk (all
P
<0.001). Physically healthier patients with no preexisting diabetes mellitus, hypertension, or dyslipidemia were at significantly greater risk (
P
<0.001), largely because they had been exposed to higher doses of antipsychotics (
P
<0.001). A study of the selected binding of antipsychotics to 14 neurotransmitter receptors revealed only dopamine type 3 receptor antagonism to be significantly associated with AMI risk (adjusted odds ratio, 2.59; 95% confidence interval, 2.43–2.75;
P
<0.0001).
Conclusions—
Antipsychotic use may be associated with a transient increase in risk for AMI, possibly mediated by dopamine type 3 receptor blockades. Further education on drug safety and research into the underlying biological mechanisms are needed.
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Affiliation(s)
- Shuai-Ting Lin
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Cheng-Chung Chen
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Hin-Yeung Tsang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Chee-Siong Lee
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Pinchen Yang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Kai-Da Cheng
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Dian-Jeng Li
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Chin-Jen Wang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Yung-Chi Hsieh
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Wei-Cheng Yang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
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