Serious outcomes associated with overdose of medicines containing barbiturates for treatment of insomnia

Ando, Shuntaro; Yasugi, Daisuke; Matsumoto, Toshihiko; Kanata, Sho; Kasai, Kiyoto

doi:10.1111/pcn.12198

Cited by 4 publications

(3 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One potential explanation for the adverse effects is that barbiturates have respiratory depressant effects [15, 24]. To our knowledge, this study is the first to quantify the comparative risk of aspiration pneumonitis between a barbiturate and benzodiazepine overdose, even though the results are similar to those of previous studies that showed the comparative risk between poisoning by barbiturates and that by any other drug [15, 29]. In addition, a previous study showed that ingestion of opioids increased the risk of aspiration pneumonitis compared to non-ingestion [21]; however, this association was not replicated in our study.…”

Section: Discussionsupporting

confidence: 72%

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

2016

View full text Add to dashboard Cite

ObjectivesSome patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course.MethodsWe conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables.ResultsOf the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60–5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18–6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines).ConclusionThese results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose.

show abstract

Section: Discussionsupporting

confidence: 72%

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

2016

View full text Add to dashboard Cite

show abstract

“…The use of benzodiazepines and barbiturates increases the risk of overdose 22, 23. Furthermore, barbiturate overdose increases the risk of a severely adverse clinical course, including aspiration pneumonia and death 11, 41. Therefore, these findings emphasize the need for psychiatrists to carefully evaluate the risk of overdose for those aged 19–49 years who have a prescription for benzodiazepines and to consider treatment alternatives for those with a prescription of barbiturates.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database

Okumura

Sakata

Takahashi

et al. 2017

Journal of Epidemiology

View full text Add to dashboard Cite

BackgroundLittle is known about the nationwide epidemiology of the annual rate, causative substance, and clinical course of overdose-related admission. We aimed to describe the epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge to home.MethodsWe assessed all cases of admission due to overdose (21,663 episodes) in Japan from October 2012 through September 2013 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.ResultsThe annual rate of overdose admission was 17.0 per 100,000 population. Women exhibited two peaks in admission rates at 19–34 years (40.9 per 100,000) and ≥75 years (27.8 per 100,000). Men exhibited one peak in the admission rate at ≥75 years (23.7 per 100,000). Within 90 days prior to overdose, ≥60% and ≥9% of patients aged 19–49 years received a prescription for benzodiazepines and barbiturates, respectively. In addition, 59% of patients aged ≥75 years received a prescription for benzodiazepines prior to overdose, 47% had a history of congestive heart failure, and 24% had a diagnosis of poisoning by cardiovascular drugs. The proportion of patients with recent psychiatric treatments decreased with age (65.1% in those aged 35–49 years and 13.9% in those aged ≥75 years).ConclusionsThe findings emphasize the need for overdose prevention programs that focus on psychiatric patients aged 19–49 years who are prescribed benzodiazepines or barbiturates and on non-psychiatric patients aged ≥75 years who are prescribed benzodiazepines or digitalis.

show abstract

“…Because of the narrow therapeutic index between the effective dose and death, barbiturates have been replaced with benzodiazepines [21]. However, barbiturates are still being prescribed for insomnia in Japan [22]-clinicians should avoid barbiturates and switch to safer hypnotics, such as orexin receptor antagonists.…”

Section: Discussionmentioning

confidence: 99%

Mortality in patients with schizophrenia in Japan

Nomura,

Misawa,

Fujii

et al. 2024

Soc Psychiatry Psychiatr Epidemiol

View full text Add to dashboard Cite

Purpose: Patients with schizophrenia have a higher mortality risk than the general population. However, no recent studies have investigated mortality in people with schizophrenia in Japan. Therefore, we conducted a retrospective study to evaluate excess mortalityand risk factors for mortality in patients with schizophrenia in Japan.Methods: We included patients diagnosed with schizophrenia or schizoaffective disorder at Yamanashi Prefectural Kita Hospital between January 1, 2013, and December 31, 2017. Standardized mortality ratios were used to compare mortality rates between patients with schizophrenia and the general population.Logistic regression analysis was performed to estimate risk factors associated with mortality.Results: Of the 1,699 patients with schizophrenia (893 men and 806 women), 104 (55 men and 49 women) died during the study period. The all-cause standardized mortality ratio (95% con dential interval [CI]) was 2.25 (1.81-2.68); the natural-and unnatural-cause standardized mortality ratios were 2.09(1.64-2.54) and 4.68 (2.63-6.74), respectively. Male sex (odds ratio [OR] = 2.24, 95% CI = 1.10-4.56), age (OR = 1.12, 95% CI = 1.09-1.16), and barbiturate use (OR = 8.17, 95% CI = 2.07-32.32) were associated with a high risk of mortality. Conclusion:The mortality rate remains high in patients with schizophrenia in Japan. Further studies are needed to evaluate mortality trends in this population.1980 to 2010 and a large cohort study in the UK conducted from 2000 to 2014 also showed an increased mortality gap between patients with schizophrenia and the general population [7,3]. In contrast, a community cohort study conducted in Southampton in the UK from 1981 to 2006 and a cohort study conducted in Finland from 1984 to 2014 reported no increase in all-cause SMR [2,8]. Moreover, living environments, including the medical systems that affect excess mortality, vary widely across countries. A meta-analysis on life expectancy in schizophrenia reported that Asian and African patients with schizophrenia have the lowest and highest potential life lost, respectively, compared to their counterparts from other regions. Thus, it is important to regularly evaluate mortality in each country for appropriate interventions to decrease excess mortality [9].Although the Japanese population has one of the longest life expectancies in the world [10], it is unclear whether this is also true for patients with schizophrenia. The difference in mortality risk between patients with schizophrenia and the general Japanese population has not recently been investigated.Three studies have reported a high mortality risk for patients with schizophrenia in Japan. Saku et al. included 2,278 patients with schizophrenia (1,433 men and 835 women) in Saga Prefecture from 1948 to 1982, and showed that the all-cause SMR was 2.55 for men and 3.02 for women. Harrison et al. reported an all-cause SMR of 5.71 for patients with schizophrenia in Nagasaki Prefecture from 1979Prefecture from to 1989. Another study that included 254 patients diagnosed...

show abstract

Serious outcomes associated with overdose of medicines containing barbiturates for treatment of insomnia

Cited by 4 publications

References 3 publications

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database

Mortality in patients with schizophrenia in Japan

Contact Info

Product

Resources

About