Metoclopramide and Levosulpiride Use and Subsequent Levodopa Prescription in the Korean Elderly: The Prescribing Cascade
Metoclopramide and Levosulpiride Use and Subsequent Levodopa Prescription in the Korean Elderly: The Prescribing Cascade
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DOI：
10.3390/jcm8091496
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发表时间：
2019-09-01
影响因子：
3.9
通讯作者：
Park, Yong-Gyu
中科院分区：
文献类型：
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作者：
Huh, Youn;Kim, Do-Hoon;Park, Yong-Gyu
本研究的目的是探讨左旋多巴等多巴胺能药物在治疗促胃动力药物引起的帕金森综合征中的处方级联现象。基于韩国国民健康保险服务(NHIS)-高级队列数据库，我们分析了2009至2013年间年龄&>=65岁的患者，他们在此期间通过NHIS获得了左旋多巴的新处方。那些在2002年至2008年期间服用左旋多巴的患者被排除在外，只有在收到左旋多巴处方后90天内服用胃复安和左旋舒必利的患者才包括在内。未接受左旋多巴治疗的患者作为对照组，进行1：3的年龄和性别匹配。我们分别评估了1824例和1197例左旋多巴的甲氧氯普胺和左旋舒必利的使用情况。每个左旋多巴病例的配对对照分别为5472例和3591例。我们使用条件Logistic回归来确定在调整了年龄、性别和接触抗精神病药物后，使用甲氧氯普胺和左旋舒必利的患者开始接受左旋多巴治疗的优势比(OR)。胃复安(OR=3.04；95%可信区间，2.46-3.77)和左旋舒必利(OR=3.32；95%可信区间，2.56-4.3)使用者开始使用含有左旋多巴的药物的可能性是非使用者的三倍。甲氧氯普胺和左旋舒必利经常在收到左旋多巴处方后90天内开出。在处方左旋多巴之前，应该考虑不良事件是否实际上是甲氧氯普胺和左旋舒必利引起的副作用。
The aim of this study was to investigate the prescribing cascade phenomenon of dopaminergic drugs such as levodopa in the management of gastroprokinetic drugs induced parkinsonism. Based on the Korea National Health Insurance Service (NHIS)-Senior Cohort Database, we analyzed patients aged >= 65 years, between 2009 and 2013, who obtained new prescriptions for levodopa through the NHIS during this period. Those who were prescribed levodopa from 2002 to 2008 were excluded, only patients who were prescribed metoclopramide and levosulpiride within 90 days of receiving the levodopa prescription were included. Those who did not receive levodopa were used as a control group for 1:3 age and sex matching. We assessed 1824 and 1197 levodopa cases for metoclopramide and levosulpiride use, respectively. The matched controls for each levodopa case were 5472 and 3591, respectively. We used conditional logistic regression to determine the odds ratio (OR) for initiation of levodopa therapy in patients using metoclopramide and levosulpiride, relative to nonusers, after adjusting for age, sex, and exposure to antipsychotic medication. Both metoclopramide (OR = 3.04; 95% confidence interval, CI, 2.46-3.77) and levosulpiride (OR = 3.32; 95% CI, 2.56-4.3) users were three times more likely to begin using medication containing levodopa, compared to nonusers. Metoclopramide and levosulpiride were frequently prescribed within 90 days of receiving a prescription for levodopa. Before prescribing levodopa, it should be considered whether the adverse event is actually a side effect caused by metoclopramide and levosulpiride.