Impact of hospital pharmacist interventions on the combination of citalopram or escitalopram with other QT-prolonging drugs

Chastang, A; Renet, Sophie; Corny, Jennifer; Beaussier, Hélène; Petre, A; Lillo‐Lelouet, Agnès; Thi, Thu-Van Tran; Bézie, Yvonnick

doi:10.1007/s11096-018-0724-7

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…However, another study also reported significant increase in psychotropic polypharmacy in a psychiatry setting with many combinations of unproven efficacy that are not supported by controlled clinical trials [11]. Recently, a study reported higher prevalence of contraindicated combinations with two antidepressants (escitalopram or citalopram) among hospitalized patients [24]. Using > 1 QT prolonging medications simultaneously increase the risk of life-threatening ventricular arrhythmias [25].…”

Section: Introductionmentioning

confidence: 99%

“…Psychiatric polypharmacy, psychotropic QT prolonging drug combinations and high dose therapies are inevitable in such a population due to multiple illnesses and tolerance to the recommended dose of therapy [13,26,27]. The increased prevalence of polypharmacy, contraindicated combinations and high dose therapy coupled with poor access to health care facilities increase the risk of QTIP associated morbidity and mortality [14,24,28].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study

et al. 2020

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Background QT interval prolongation is a growing concern worldwide, posing psychiatric patients to life-threatening fatal arrhythmias i.e., torsade de pointes. This study aimed to identify the prevalence of QT interval prolongation, its associated risk factors and prescribing patterns of QT prolonging drugs among psychiatric patients. Method A prospective observational study was conducted that included psychiatric patients from a tertiary care hospital and a psychiatry clinic in Peshawar, Khyber Pakhtunkhwa, Pakistan. Electrocardiogram was recorded of those patients who were using psychotropic medications for ≥7 days, aged 18 years or more, and of either gender, male or female. The Fredericia correction formula was used for measuring QTc values (corrected QT). Chi-square test was applied to estimate differences between patients with or without prolonged QTc interval whereas, logistic regression analysis was performed to identify various predictors of QT interval prolongation. Results Out of 405 patients, the QTc interval was prolonged in 23 (5.7%) patients including 1 (0.2%) patient with highly abnormal prolonged QTc interval (> 500 ms). QT drugs (91.6%), female sex (38.7%) and hypertension (10.6%) were the most common QT prolonging risk factors. Prolonged QTc interval was significantly higher among male patients (p = 0.007). Conclusion In the present study, QT interval prolongation was observed in a considerable number of psychiatric patients. While, the high prevalence of QT prolonging risk factors among these patients warrants the increased risk of fatal arrhythmias. Therefore, risk assessment and electrocardiographic monitoring, and prescription of safer alternatives are highly recommended.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study

et al. 2020

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“…* Some of the studies are underpowered to detect a difference and do not show statistically significant outcomes. 31,33,56,69,70,72 Psychiatric pharmacists also show statistically significant benefits on patient-level outcomes in at least 5 peer-reviewed publications by providing services, including medication reviews, patient education, à patient and/or data evaluation for medication safety and efficacy, 26,31,35,37,40,41,47 and independent management of medication therapy upon referral. 50,[76][77][78][79]81 Twenty (31.3%) of the included studies have at least 1 BCPP author with formal advanced training in psychiatry/ neurology.…”

Section: Resultsmentioning

confidence: 99%

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders

Werremeyer

Bostwick

Cobb³

et al. 2020

Mental Health Clinician

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Introduction Psychiatric and neurologic illnesses are highly prevalent and are often suboptimally treated. A 2015 review highlighted the value of psychiatric pharmacists in improving medication-related outcomes. There is a need to describe areas of expansion and strengthened evidence regarding pharmacist practice and patient care impact in psychiatric and neurologic settings since 2015. Methods A systematic search of literature published from January 2014 to June 2019 was conducted. Publications describing patient-level outcome results associated with pharmacist provision of care in a psychiatric/neurologic setting and/or in relation to central nervous system (CNS) medications were included. Results A total of 64 publications were included. There was significant heterogeneity of published study methods and data, prohibiting meta-analysis. Pharmacists practicing across a wide variety of health care settings with focus on CNS medication management significantly improved patient-level outcomes, such as medication adherence, disease control, and avoidance of hospitalization. The most common practice approach associated with significant improvement in patient-level outcomes was incorporation of psychiatric pharmacist input into the interprofessional health care team. Discussion Pharmacists who focus on psychiatric and neurologic disease improve outcomes for patients with these conditions. This is important in the current health care environment as most patients with psychiatric or neurologic conditions continue to have unmet needs. Additional studies designed to measure pharmacists' impact on patient-level outcomes are encouraged to strengthen these findings.

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“…Although prescribers might not have in mind all QT drugs and do not consult the SmPC or CredibleMeds ® database regularly, they should at least update their knowledge on a regular basis regarding the few most frequently prescribed QT drugs and consider common further risk factors like age, gender, or comorbidities as contributors to the overall risk of LQTS to stratify monitoring of certain patients 43,47 . The increasing polypharmacy along with the increasing potential for DDIs leading to QT interval–prolongation additionally supports the efforts to implement an interdisciplinary medication management, e.g., by integrating medication review by clinical pharmacists and clinical pharmacologists into the clinical routine, leading to better prevention of inappropriate medication 48,49 . Validated clinical decision support systems focusing on clinically relevant medication issues can help to facilitate avoidance or detection of medication errors 50 …”

Section: Discussionmentioning

confidence: 99%

“…43,47 The increasing polypharmacy along with the increasing potential for DDIs leading to QT interval-prolongation additionally supports the efforts to implement an interdisciplinary medication management, e.g., by integrating medication review by clinical pharmacists and clinical pharmacologists into the clinical routine, leading to better prevention of inappropriate medication. 48,49 Validated clinical decision support systems focusing on clinically relevant medication issues can help to facilitate avoidance or detection of medication errors. 50 Within the framework of this study, we could not differentiate whether the cause for the co-prescribing of QT drugs was direct negligence or the result of an individual risk-benefit assessment indicating the lack of clinically better alternatives.…”

Section: Articlementioning

confidence: 99%

Development in Prescriptions of Contraindicated and Potentially Harmful QT Interval–Prolonging Drugs in a Large Geriatric Inpatient Cohort From 2011 to 2021

Then

Tümena²,

Sledziewska

et al. 2023

Clin Pharma and Therapeutics

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Regulatory authorities put major emphasis on QT (interval)-prolonging properties of new molecular entities. Product information/Summaries of Product Characteristics (SmPCs) of multiple drugs contain warnings or contraindications regarding QT prolongation, e.g., on coadministration of QT-prolonging drugs (QT drugs). To characterize the development of the QT drug burden, we performed a trend analysis of prescriptions and co-prescriptions of QT drugs in a large geriatric inpatient cohort. The German SmPCs (status of 2014 and of 2021) and the year-wise listings in the CredibleMeds® database from 2011 to 2021 were used as sources. There were 402,631 geriatric cases included. The group of QT drugs according to SmPCs in 2014, which must not be combined with other QT drugs, was less frequently involved in contraindicated co-prescriptions in 2021 compared with 2015 (3.0% (2.5-3.7%) of cases with at least one of those drugs in 2021 vs. 4.0% (3.5-4.5%) in 2015), with citalopram, escitalopram, and amiodarone involved in nearly 90% of the co-prescriptions. The number of CredibleMeds-QT-drugs per patient increased from 0.4 (SD=1.1) in 2011 to 1.8 (SD=3.9) in 2021. The percentage of contraindicated co-prescriptions of drugs with known risk for torsade de pointes according to CredibleMeds® listings at the beginning of the respective years increased from 1.7% in 2011 to 6.1% in 2021. Considering the regularly updated CredibleMeds® QT drugs list, the contraindicated co-prescriptions of QT drugs markedly increased in the last decade. If prescribers considered only the few most frequently (co-) prescribed QT drugs, then most of the medication errors regarding QT drugs could be prevented.The drug-induced long QT syndrome (diLQTS) poses an adverse event that can result in torsades de pointes arrhythmia (TdP) and sudden cardiac death. 1,2 Molecular mechanisms leading to diLQTS are complex. 3 Among others, genetic predispositions contributing to the phenotype of long QT syndrome (LQTS) make it difficult to stratify patients at increased risk for TdP. 3 The incidence of TdP

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Impact of hospital pharmacist interventions on the combination of citalopram or escitalopram with other QT-prolonging drugs

Cited by 6 publications

References 31 publications

Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study

Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders

Development in Prescriptions of Contraindicated and Potentially Harmful QT Interval–Prolonging Drugs in a Large Geriatric Inpatient Cohort From 2011 to 2021

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