Cargando…

Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand

BACKGROUND: The US FDA has designated pimozide, thioridazine, and ziprasidone as contraindicated for patients at risk of QT interval prolongation, and assigned haloperidol, olanzapine, paliperidone, quetiapine, and risperidone as associated with a significant risk of QT prolongation. This study aime...

Descripción completa

Detalles Bibliográficos
Autores principales: Waleekhachonloet, Onanong, Limwattananon, Chulaporn, Rattanachotphanit, Thananan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566479/
https://www.ncbi.nlm.nih.gov/pubmed/31223470
http://dx.doi.org/10.1177/2042098619854886
_version_ 1783426861621051392
author Waleekhachonloet, Onanong
Limwattananon, Chulaporn
Rattanachotphanit, Thananan
author_facet Waleekhachonloet, Onanong
Limwattananon, Chulaporn
Rattanachotphanit, Thananan
author_sort Waleekhachonloet, Onanong
collection PubMed
description BACKGROUND: The US FDA has designated pimozide, thioridazine, and ziprasidone as contraindicated for patients at risk of QT interval prolongation, and assigned haloperidol, olanzapine, paliperidone, quetiapine, and risperidone as associated with a significant risk of QT prolongation. This study aimed to examine trends and hospital variations in concomitant prescribing among these eight selected antipsychotics, and coprescription with interacting drugs known to increase QT prolongation risk. METHODS: Data on outpatient antipsychotic prescriptions during 2012–2015 were obtained from 16 general hospitals and 10 university hospitals nationwide. A time-series analysis was used for estimating trends in coprescription that led to drug interactions. RESULTS: Coprescribing among the eight antipsychotics ranged from 7.5% for quetiapine to 33.1% for thioridazine. The rate of coprescription with contraindicated interacting drugs was 9.7% for thioridazine and 21.9% for pimozide, and increased by 1.1 and 1.4 percentage points (% pt.) yearly for thioridazine in general and university hospitals, respectively. Coprescribing with interacting drugs with precautions was 2.8% for quetiapine, 7.4% for ziprasidone, and 27.9% for risperidone; these percentages increased yearly by 1.7% pt. for ziprasidone and 2.6% pt. for risperidone in general hospitals, as well as by 1.0% pt. for risperidone in university hospitals. The median proportion of patients exposed to a QT-prolonging interaction was 12.3% across hospitals (interquartile range, 9.9–19.5%). Wide interhospital variation was found in percentages of drug interactions among patients receiving thioridazine, ziprasidone, paliperidone, or olanzapine in general hospitals, and among patients receiving paliperidone or pimozide in university hospitals. CONCLUSIONS: Coprescription of antipsychotics with interacting drugs that could increase the risk of QT prolongation was common in Thailand, and thioridazine, ziprasidone, and risperidone showed increasing trends. We urge the incorporation of a unified list of QT-prolonging antipsychotics and interacting drugs into a computerized drug interaction warning system, and existing national rational drug use campaigns should cover this important issue.
format Online
Article
Text
id pubmed-6566479
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-65664792019-06-20 Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand Waleekhachonloet, Onanong Limwattananon, Chulaporn Rattanachotphanit, Thananan Ther Adv Drug Saf Original Research BACKGROUND: The US FDA has designated pimozide, thioridazine, and ziprasidone as contraindicated for patients at risk of QT interval prolongation, and assigned haloperidol, olanzapine, paliperidone, quetiapine, and risperidone as associated with a significant risk of QT prolongation. This study aimed to examine trends and hospital variations in concomitant prescribing among these eight selected antipsychotics, and coprescription with interacting drugs known to increase QT prolongation risk. METHODS: Data on outpatient antipsychotic prescriptions during 2012–2015 were obtained from 16 general hospitals and 10 university hospitals nationwide. A time-series analysis was used for estimating trends in coprescription that led to drug interactions. RESULTS: Coprescribing among the eight antipsychotics ranged from 7.5% for quetiapine to 33.1% for thioridazine. The rate of coprescription with contraindicated interacting drugs was 9.7% for thioridazine and 21.9% for pimozide, and increased by 1.1 and 1.4 percentage points (% pt.) yearly for thioridazine in general and university hospitals, respectively. Coprescribing with interacting drugs with precautions was 2.8% for quetiapine, 7.4% for ziprasidone, and 27.9% for risperidone; these percentages increased yearly by 1.7% pt. for ziprasidone and 2.6% pt. for risperidone in general hospitals, as well as by 1.0% pt. for risperidone in university hospitals. The median proportion of patients exposed to a QT-prolonging interaction was 12.3% across hospitals (interquartile range, 9.9–19.5%). Wide interhospital variation was found in percentages of drug interactions among patients receiving thioridazine, ziprasidone, paliperidone, or olanzapine in general hospitals, and among patients receiving paliperidone or pimozide in university hospitals. CONCLUSIONS: Coprescription of antipsychotics with interacting drugs that could increase the risk of QT prolongation was common in Thailand, and thioridazine, ziprasidone, and risperidone showed increasing trends. We urge the incorporation of a unified list of QT-prolonging antipsychotics and interacting drugs into a computerized drug interaction warning system, and existing national rational drug use campaigns should cover this important issue. SAGE Publications 2019-06-13 /pmc/articles/PMC6566479/ /pubmed/31223470 http://dx.doi.org/10.1177/2042098619854886 Text en © The Author(s), 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Waleekhachonloet, Onanong
Limwattananon, Chulaporn
Rattanachotphanit, Thananan
Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand
title Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand
title_full Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand
title_fullStr Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand
title_full_unstemmed Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand
title_short Coprescription of QT interval-prolonging antipsychotics with potentially interacting medications in Thailand
title_sort coprescription of qt interval-prolonging antipsychotics with potentially interacting medications in thailand
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566479/
https://www.ncbi.nlm.nih.gov/pubmed/31223470
http://dx.doi.org/10.1177/2042098619854886
work_keys_str_mv AT waleekhachonloetonanong coprescriptionofqtintervalprolongingantipsychoticswithpotentiallyinteractingmedicationsinthailand
AT limwattananonchulaporn coprescriptionofqtintervalprolongingantipsychoticswithpotentiallyinteractingmedicationsinthailand
AT rattanachotphanitthananan coprescriptionofqtintervalprolongingantipsychoticswithpotentiallyinteractingmedicationsinthailand