Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

Das, Biswadeep; Ramasubbu, Saravana Kumar; Agnihotri, Akash; Kumar, Barun; Rawat, Vikram Singh

doi:10.1177/17539447211058892

Cited by 15 publications

(27 citation statements)

References 56 publications

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“…The most common psychiatric diagnoses in our study population were dementia, substance use disorders, depression, and delirium, which is comparable to other studies (26,29,30). Previous studies examined the frequency and significance of risk factors for QT c prolongation in psychiatric patients (21,23,24,31).…”

Section: Discussionsupporting

confidence: 91%

“…Different study designs, enrollment of both inpatients and outpatients, as well as different age profiles of the participants may serve as explanations for these discrepancies. To date, three studies investigated the characteristics of QT c prolongation in geriatric psychiatry (26)(27)(28). Dumontet et al (28) found that in a sample of 88 inpatients, 29.4% of men and 21.4% of women displayed QT c prolongation.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

et al. 2023

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IntroductionQTc prolongation carries the risk of ventricular tachyarrhythmia (Torsades de Pointes) and sudden cardiac death. Psychotropic drugs can affect ventricular repolarization and thus prolong the QTc interval. The present study sought to investigate the risk factors (pharmacological and non-pharmacological) of severe QTc prolongation in gerontopsychiatric patients.MethodsElectrocardiograms of patients on a gerontopsychiatric ward were screened for QTc prolongation. Medication lists were examined utilizing the AzCERT classification. Potential drug interactions were identified with the electronic drug interaction program mediQ.ResultsThe overall prevalence of QTc prolongation was 13.6%, with 1.9% displaying severe QTc prolongation (≥ 500 ms). No statistically significant differences between patients with moderate and severe QTc prolongation were identified; however, patients with severe QTc prolongation tended to take more drugs (p = 0.063). 92.7% of patients with QTc prolongation took at least one AzCERT-listed drug, most frequently risperidone and pantoprazole. Risperidone and pantoprazole, along with pipamperone, were also most frequently involved in potential drug interactions. All patients displayed additional risk factors for QTc prolongation, particularly cardiac diseases.ConclusionIn addition to the use of potentially QTc-prolonging drugs, other risk factors, especially cardiac diseases, appear to be relevant for the development of QTc prolongation in gerontopsychiatric patients. Pantoprazole was frequently involved in potential drug interactions and should generally not be used for more than 8 weeks in geriatric populations. As clinical consequences of QTc prolongation were rare, potentially QTc-prolonging drugs should not be used overcautiously; their therapeutic benefit should be considered as well. It is paramount to perform diligent benefit–risk analyses prior to the initiation of potentially QTc-prolonging drugs and to closely monitor their clinical (side) effects.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

et al. 2023

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“…A recently published meta‐analysis which was limited to drug–drug‐interactions (DDIs) leading to QT prolongation in psychiatric patients has estimated an incidence of 42% among the patients, and the factors age, polypharmacy, and comorbidity were significantly associated with the occurrence of potential QT drug DDIs 36 . Similarly, many other studies on the prevalence of QT drugs in older persons are limited to antipsychotic drugs or psychiatric patients 37 . In contrast, we conducted a very broad analysis including all QT drugs to follow‐up on our 2016 study.…”

Section: Discussionmentioning

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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“…Elderly patients are at a higher risk for polypharmacy, which is why Das et al have investigated medications with an impact on the QT interval, which relates to a higher risk of cardiovascular death and all-cause mortality ( 12 ). They identified that antidepressant, proton pump inhibitor, antipsychotic, antinausea, antimicrobial, and H2 receptor antagonist medications have highest interactions with inclination to toward QT-interval prolongation.…”

Section: Psychotropic Drug Interactionsmentioning

confidence: 99%

“…They identified that antidepressant, proton pump inhibitor, antipsychotic, antinausea, antimicrobial, and H2 receptor antagonist medications have highest interactions with inclination to toward QT-interval prolongation. They concluded that reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com should be adopted to facilitate medication selection ( 12 ). A recent retrospective analysis conducted in 10 psychiatric hospitals in Germany has shown that 22,739 (83%) cases received 1–8 QT interval prolonging medications simultaneously, of which pipamperone, quetiapine, prothipendyl, and risperidone were the most common.…”

Section: Psychotropic Drug Interactionsmentioning

confidence: 99%

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

et al. 2022

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Hemodialysis (HD) is the most common method of chronic kidney failure (CKF) treatment, with 65% of European patients with CKF receiving HD in 2018. Regular two to three HD sessions weekly severely lower their quality of life, resulting in a higher incidence of depression and anxiety, which is present in one third to one half of these patients. Additionally, the age of patients receiving HD is increasing with better treatment and care, resulting in more cognitive impairment being uncovered. Lastly, patients with other mental health issues can also develop CKF during their life with need for kidney replacement therapy (KRT). All these conditions need to receive adequate care, which often means prescribing psychotropic medications. Importantly, many of these drugs are eliminated through the kidneys, which results in altered pharmacokinetics when patients receive KRT. This narrative review will focus on common issues and medications of CKF patients, their comorbidities, mental health issues, use of psychotropic medications and their altered pharmacokinetics when used in HD, polypharmacy, and drug interactions, as well as deprescribing algorithms developed for these patients.

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Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

Cited by 15 publications

References 56 publications

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

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

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

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