Health Canada Warning on Citalopram and Escitalopram-Its Effects on Prescribing in Consultation-Liaison Psychiatry
Health Canada Warning on Citalopram and Escitalopram-Its Effects on Prescribing in Consultation-Liaison Psychiatry
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DOI：
10.1016/j.psym.2015.09.003
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发表时间：
2016-01-01
期刊：
影响因子：
3.4
通讯作者：
Rej, Soham
中科院分区：
文献类型：
--
作者：
Do, Andre;Noohi, Saeid;Rej, Soham
背景资料：有报告表明，西酞普兰和依他普仑可能会延长QTc间期，导致加拿大卫生部在2012年发出警告，限制其剂量。关于这个警告和类似警告的影响（例如，美国食品和药物管理局）对急性内科疾病住院患者的抗抑郁药处方，这些患者理论上具有QTc延长的高风险。我们研究的主要目的是检查加拿大卫生部警告对咨询联络（C-L）精神病学设置中西酞普兰处方模式的影响。研究方法：我们进行了一项回顾性队列研究，包括2008年至2014年期间由加拿大一家大型学术医院的精神科C-L团队评估的275名随机选择的内科疾病住院患者。我们根据C-L团队在西酞普兰加拿大卫生部警告之前或之后对患者进行了评估。我们的主要结果是西酞普兰处方模式的改变。结果如下：我们发现，在加拿大卫生部警告之前就诊的患者中，即使在控制了混杂因素之后，仍有显著更高数量的患者接受了西酞普兰治疗（44.1% vs. 22.3%，chi（2）= 14.835，p < 0.001）。然而，两组中使用超过加拿大卫生部警告推荐剂量的西酞普兰的患者百分比相似（8.9%与12.1%，chi（2）= 0.233，p = 0.63）。结论：总体而言，C-L精神科医生在加拿大卫生部警告后不太可能开西酞普兰，这并没有转化为更安全的剂量。当利大于弊时，临床医生不应避免对医学上脆弱的住院患者适当地开具西酞普兰。
Background: Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who are theoretically at high risk of QTc prolongation. The main objective of our study is to examine the effect of the Health Canada warning on citalopramlescitalopram prescribing patterns in the consultation-liaison (C-L) psychiatry setting. Methods: We performed a retrospective cohort study including 275 randomly selected inpatients with medical illness assessed by the psychiatric C-L team of a large Canadian academic hospital between 2008 and 2014. We grouped patients based on whether they were assessed by the C-L team before or after the citalopram Health Canada warning. Our primary outcome was change in citalopramlescitalopram prescribing patterns. Results: We found that of patients seen before the Health Canada warning, a significantly higher number were prescribed citalopramlescitalopram (44.1% vs. 22.3%, chi(2) = 14.835, p < 0.001), even after controlling for confounders. However, the percentage of patients using a citalopramlescitalopram dose exceeding those recommended by the Health Canada warning was similar in both groups (8.9% vs. 12.1%, chi(2) = 0.233, p = 0.63). Conclusions: Overall, C-L psychiatrists were less likely to prescribe citalopramlescitalopram following the Health Canada warning, which did not translate into safer dosing. Clinicians should not avoid prescribing citalopramlescitalopram appropriately in medically vulnerable inpatients when benefits outweigh disadvantages.