Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults - a Swedish nationwide study
Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults - a Swedish nationwide study
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DOI：
10.1111/bcp.12829
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发表时间：
2016-04-01
影响因子：
3.4
通讯作者：
Fastbom, Johan
中科院分区：
文献类型：
--
作者：
Danielsson, Bengt;Collin, Julius;Fastbom, Johan
AimThe目的的研究是检查死亡风险与使用抗抑郁药和抗精神病药分类与尖端扭转型室性心动过速（TdP）的风险在elderly.MethodsA匹配的病例对照登记研究进行了65岁及以上的人死在医院外，从2008年至2013年（n=286092）和匹配的控制（n=1430460）。根据CredibleMeds（），抗抑郁药和抗精神病药处方与各种TdP风险和全因死亡率之间的关联通过多变量条件Logistic回归进行了研究，调整了合并症和其他几个混杂因素。（OR 1.53，95% CI 1.51，1.56和OR 1.63，95% CI 1.61，1.67）与分类为条件性TdP风险（OR 1.25，95% CI 1.22，1.28）或无TdP分类（OR 0.99，95% CI 0.94，1.05）的抗抑郁药相比。已知TdP风险的抗精神病药物与风险（OR 4.57，95% CI 4.37，4.78）高于可能风险（OR 2.58，95% CI 2.52，2.64）或无TdP分类（OR 2.14，95% CI 2.03，2.65）的抗精神病药物。以下风险排名观察到常用的抗抑郁药：米氮平>西酞普兰>舍曲林>阿米替林和抗精神病药：氟哌啶醇>利培酮>奥氮平> quetiblid.ConclusionThe CredibleMeds系统预测药物相关的风险，在老年人的死亡率在风险等级水平。在抗精神病药物中，氟哌啶醇，抗抑郁药物中，米氮平和西酞普兰与最高风险相关。结果表明，在给老年人开处方时，应考虑抗抑郁药和抗精神病药的TdP风险。
AimThe aim of the study was to examine mortality risk associated with use of antidepressants and antipsychotics classified with torsades de pointes (TdP) risk in elderly.MethodsA matched case-control register study was conducted in people 65 years and older dying outside hospital from 2008-2013 (n=286092) and matched controls (n=1430460). The association between prescription of antidepressants and antipsychotics with various TdP risk according to CredibleMeds () and all-cause mortality was studied by multivariate conditional logistic regression adjusted for comorbidity and several other confounders.ResultsUse of antidepressants classified with known or possible TdP risk, was associated with higher adjusted risk for mortality (OR 1.53, 95% CI 1.51, 1.56 and OR 1.63, 95% CI 1.61, 1.67, respectively) compared with antidepressants classified with conditional TdP risk (OR 1.25, 95% CI 1.22, 1.28) or without TdP classification (OR 0.99, 95% CI 0.94, 1.05). Antipsychotics classified with known TdP risk were associated with higher risk (OR 4.57, 95% CI 4.37, 4.78) than antipsychotics with possible risk (OR 2.58, 95% CI 2.52, 2.64) or without TdP classification (OR 2.14, 95% CI 2.03, 2.65). The following risk ranking was observed for commonly used antidepressants: mirtazapine > citalopram > sertraline > amitriptyline and for antipsychotics: haloperidol > risperidone >olanzapine > quetiapine.ConclusionThe CredibleMeds system predicted drug-associated risk for mortality in the elderly at the risk class level. Among antipsychotics, haloperidol, and among antidepressants, mirtazapine and citalopram, were associated with the highest risks. The results suggest that the TdP risk with antidepressants and antipsychotics should be taken into consideration when prescribing to the elderly.