Impaired glucose homeostasis after imipramine intake in a diabetic patient.
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Antidepressive Agents, Tricyclic↗
Biomedical subjects
Eibert R Heerdink
Publications and source records attributed to Eibert R Heerdink.
Drug-drug interactions as a determinant of elevated lithium serum levels in daily clinical practice.
OBJECTIVE: Lithium is a drug with a narrow therapeutic window. Concomitantly used medication is a potentially influencing factor of lithium serum concentrations. We conducted a multicentre retrospective case-control study with the aim of investigating lithium-related drug interactions as determinants of elevated lithium serum levels in daily clinical practice. METHODS: Cases were patients with an increase of at least 50% in lithium serum concentrations resulting in an elevated lithium serum level of at least 1.3 mmol/L, and who were not suspected of a suicide attempt. Controls were patients who showed stable lithium serum levels within the therapeutic range. Use and start of non-steroidal anti-inflammatory drugs, diuretics, renin-angiotensin inhibitors, theophyllin and antibiotics were investigated as potential determinants of the elevated lithium serum levels. Irregularity in lithium dispensing pattern, change in lithium dosing regimen, age, gender, prescribing physician and laboratory parameters were investigated as potential confounders. RESULTS: We included 51 cases and 51 controls in our study. Five (9.8%) controls and 15 (29.4%) cases used potentially interacting co-medication [OR of 3.83 (95%CI 1.28-11.48)]. Start of potentially interacting co-medication was observed in eight (15.7%) cases and in zero (0%) controls resulting in an OR of 20.13 (95% CI 1.13-359). After adjustment for co-medication, irregularity in lithium dispensing pattern, change in lithium dosing regimen, and age, the statistically significant association was lost. We report an OR of 2.70 (95% CI 0.78-9.31) for use of concomitant medication, with a large contribution of antibiotic agents, and an OR of 3.14 (95% CI 1.15-8.61) for irregularity in lithium dispensing pattern. CONCLUSION: Use of co-medication, especially antibiotics, tends to be associated with elevated lithium serum levels.
Angiotensin-Converting Enzyme Inhibitors↗
Psychoactive drug prescribing by Dutch child and adolescent psychiatrists.
AIM: To gain more insight into the prescribing of psychoactive drugs by Dutch child psychiatrists. METHODS: A questionnaire was sent to all child psychiatrists in the Netherlands. Questions were asked about the prescribing of antidepressants, antipsychotics, anxiolytics and psychostimulants for psychiatric disorders in children. RESULTS: The preference of specific antidepressants, antipsychotics and anxiolytics depends on the disorder. For different disorders, off-label prescribing varies from 19 to 71%. CONCLUSION: Preferences differ widely. Off-label drug prescribing is high. More studies on the efficacy and safety of psychoactive drugs in children are therefore required.
Adolescent↗
Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants.
BACKGROUND: Serotonin plays a role in platelet aggregation. Because antidepressants influence blood serotonin levels, their use may be associated with an increased risk of abnormal bleeding. However, previous studies were inconclusive regarding this association. The aim of this study was to estimate the risk of abnormal bleeding associated with the use of antidepressants and to establish the relationship between serotonin reuptake inhibition and the risk of bleeding. METHODS: We used data collected from 1992 through 2000 to conduct a nested case-control study of a cohort of more than 64 000 new antidepressant users. Cases were identified as all patients hospitalized for a primary diagnosis of abnormal bleeding, and they were matched with controls for age and sex. We classified exposure according to the degree (high, intermediate, or low) of serotonin reuptake inhibition and performed logistic regression analysis to calculate odds ratios. RESULTS: There were 196 cases of abnormal bleeding. The risk of hospitalization increased with the use of inhibitors providing intermediate (odds ratio, 1.9; 95% confidence interval, 1.1-3.5) and high degrees of serotonin reuptake inhibition (odds ratio, 2.6; 95% confidence interval, 1.4-4.8). CONCLUSIONS: In a large population of new antidepressant users we found a significant association between degree of serotonin reuptake inhibition by antidepressants and risk of hospital admission for abnormal bleeding as the primary diagnosis. An increased risk of abnormal bleeding was strongly associated with the degree of serotonin reuptake inhibition.
Antidepressive Agents↗
Correlated measures in longitudinal analysis of daily drug use patterns in a general intensive care unit.
PURPOSE: The objective of the present study is to compare two different study designs (with and without corrections for correlated measures) to identify possible determinants of psychotropic drug use in an intensive care unit (ICU). METHODS: In a logistic regression analysis, odds ratios (OR) were calculated for days in which patients were exposed to psychotropics compared with non-exposed days. In order to adjust for correlated measures, logistic regression with a logistic binomial model was applied. RESULTS: We found that adjustment for correlated measures did not result in major changes in the OR. However, with more observations per patient parameter, adjustment for correlation has greater effect. CONCLUSIONS: Adjustment for correlated measures may be useful in longitudinal drug analyses.
APACHE↗
Less medication switching after initial start with atypical antipsychotics.
We investigated the extent and time of switching to another oral antipsychotic in newly admitted in-patients that started oral antipsychotic therapy. In a retrospective follow-up study of 522 newly admitted patients who started with an oral antipsychotic, we applied a case-control analysis considering patients switching to another oral antipsychotics as cases. Association between patient characteristics and switching antipsychotic medication was evaluated using logistic regression analysis. A Kaplan-Meier plot was performed to analyse time to switch. Patients initially treated with an oral typical antipsychotic showed a twofold increased risk to switch to another antipsychotic compared to patients treated with an oral atypical antipsychotic (adjusted OR=1.79 95% CI=1.15-2.78). The Kaplan-Meier survival analysis revealed that patients started with a typical antipsychotic switched sooner compared to patients on atypical antipsychotics. Atypical antipsychotics are less frequently associated with switching in comparison with typical antipsychotics suggesting overall better treatment satisfaction.
Administration, Oral↗
The association between compliance with antihypertensive drugs and modification of antihypertensive drug regimen.
BACKGROUND: Non-compliance is an important factor in lack of control of blood pressure. Uncontrolled blood pressure, as well as patients' complaints about the prescribed medication, may lead to modification of the initially prescribed antihypertensive drug regimen. The objective of this study was to assess the association between non-compliance and change in medication regimen. METHODS: A nested case-control study within a cohort of new users of antihypertensive drugs between 1 January 1999 and 31 December 2002. We used data from the PHARMO database, a record linkage system containing drug-dispensing records from community pharmacies and linked hospital discharge records of approximately 950,000 subjects. Cases were subjects whose initial drug regimen was modified. Controls did not undergo such a modification. Conditional logistic regression was used to calculate odds ratios (OR) and their 95% confidence intervals (CI), and to adjust for confounders. RESULTS: In a cohort of 39,714 new users of antihypertensive drugs, we identified 11,937 cases and 11,937 matched controls. The percentage of non-compliant patients (compliance < 80%) among cases and controls was 5.1 and 3.6%, respectively [OR 1.39 (95% CI: 1.22-1.58)]. The association is stronger in females [OR 1.64 (95%CI: 1.37-1.94)] than in males [OR 1.14 (95% CI: 0.94-1.40)] and stronger if the duration of episode of use is longer than 6 months. CONCLUSION: Non-compliance is significantly associated with the occurrence of change in antihypertensive medication regimen. Pharmacists and physicians can use pharmacy data, although data tend to overestimate actual compliance, to assess and improve compliance with antihypertensive drugs, before modifying treatment regimens.
Aged↗
Channelling new antidepressants to problem patients may be factor in fatal toxicity.
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Antidepressive Agents↗
Short-acting parenteral antipsychotics drive choice for classical versus atypical agents.
OBJECTIVE: The objective of this study was to investigate which antipsychotics (classical versus atypical) are prescribed in a psychiatric hospital and which determinants affect the choice for one of these two classes of antipsychotics in newly admitted patients. METHODS: In a retrospective cohort design, 522 newly admitted patients were followed from the date of admission until discharge from the hospital. In the cohort of newly admitted patients treated with an oral antipsychotic, a nested case-control study was conducted considering recipients of an atypical agent as cases. Controls were all other cohort members. The association of patient characteristics and the choice between classical versus atypical antipsychotics was studied using logistic regression analysis. The same analysis was performed with adjustment for possible confounding factors (age group, gender, DSM-IV diagnoses, use of short-acting parenteral antipsychotic, global assessment of functioning score, involuntary admissions and involuntary measures). RESULTS: Patients treated with classical oral antipsychotics were more often previously treated with short-acting parenteral antipsychotics than patients treated with atypical antipsychotics (40.8% vs 15.2%; adjusted OR=0.20 95% CI=0.09-0.44). No statistically significant difference was found between patients with different severities of disease. DISCUSSION: Availability of injectable forms seems to drive the choice for oral antipsychotic agents. Future introductions of short-acting parenteral atypical antipsychotics may have a large impact on first-choice oral antipsychotic treatment.
Administration, Oral↗
Refill compliance in type 2 diabetes mellitus: a predictor of switching to insulin therapy?
OBJECTIVE: To assess whether switching to insulin therapy in patients with type 2 diabetes mellitus is associated with medication refill compliance of oral hypoglycemic agents. RESEARCH DESIGN AND METHODS: The PHARMO Record Linkage System was used as data source for this study. Patients with newly treated type 2 diabetes mellitus were defined as subjects in whom oral hypoglycemic therapy was initiated between 1991 and 1998. We performed a matched case-control study in this cohort. Cases were patients who switched to insulin therapy. Date of switching in the case was defined as the index date. Controls were subjects still on oral therapy on the index date, matched on duration of diabetes and calendar time. We measured the medication refill compliance in the year starting 18 months before the index date and calculated various compliance indices. RESULTS: In total, 411 cases and 411 matched controls were identified. Cases suffered more often from more severe comorbidity and used a higher number of oral hypoglycemic agents and concomitant non-diabetic drugs. The overall compliance rate did not differ significantly between cases and controls, the adjusted odds ratio (OR) was 1.3 (CI 95% 0.6-2.8). After performing multivariate logistic regression modeling, age at onset of diabetes, gender, comedication, combination therapy, and daily dosage frequency, were independently related to switching. CONCLUSIONS: We were unable to confirm the hypothesis that noncompliance with treatment is more prevalent in patients with secondary failure. Other variables, like comorbidity and disease-related factors seem to play a more important role in switching to insulin therapy.
Administration, Oral↗
Patterns of pharmacotherapy in patients hospitalised for congestive heart failure.
BACKGROUND: In the 1990s, a number of cardiovascular drugs were evaluated in randomised clinical trials. Treatment guidelines for heart failure were modified to include these evidence-based treatments. AIM: To evaluate the impact of new medical treatments for heart failure between 1990 and 1998. METHODS AND RESULTS: A retrospective cohort study of 2764 patients with a first hospital admission for heart failure between 1990 and 1998. The percentage of patients treated with different cardiovascular drugs after hospitalisation was calculated and compared over time. Use of loop diuretics remained steady approximately 80%, digoxin decreased from 57.6 to 42.7%, angiotensin converting enzyme (ACE) inhibitors showed a slight increase from 49.8 to 54.8%, beta-blockers almost tripled from 11.3 to 28.7%, low dose prophylactic acetylsalicylic acid quadrupled from 9.9 to 39.9%. Kaplan-Meier survival estimates showed highest continuation rates of drug treatment for antithrombotics and diuretics, intermediate for digoxin and ACE inhibitors and low for beta-blockers. More than a quarter of the users discontinued beta-blockers in the first year after hospitalisation. CONCLUSIONS: We observed an increase in the prescribing of several important drug classes, reflecting changes in treatment guidelines during the study period. However, our findings show that not all patients were receiving optimal treatment. More research into the reasons for this is warranted.
Adrenergic beta-Antagonists↗
Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study.
BACKGROUND: Noncompliance is a major factor in the morbidity and unnecessary hospital readmissions for patients with heart failure. Several studies have aimed to reduce rehospitalizations in heart failure patients through a comprehensive, multidisciplinary approach. Medication compliance was rarely measured in these studies or, when it was measured, the method employed was seldom valid. We aimed at determining the effect of a pharmacist-led intervention on medication compliance in patients with heart failure. METHODS: We conducted a randomized controlled trial into the effect of a pharmacist-led intervention on medication compliance in patients with heart failure (predominantly New York Heart Association [NYHA] II and III) treated with loop diuretics, presenting to a cardiology outpatient clinic or admitted to hospitals in The Netherlands. Patients in the intervention group received monthly consultations from their community pharmacist during a 6-month period. Patients in the control group received usual care. Primary endpoint was medication compliance, assessed with a medication event monitoring system, an electronic pill bottle that registers time of opening. Secondary endpoints were the number of rehospitalizations, death, and quality of life. RESULTS: A total of 152 patients were randomized: 74 patients to the intervention arm and 78 patients to the usual care arm. Over the 6-month study period, patients in the intervention group had 140/7656 days without use of loop diuretics compared with 337/6196 days in the usual care group (relative risk 0.33 [confidence interval (CI) 95% 0.24-0.38]). Two consecutive days of nondosing occurred on 18/7656 days in the intervention group compared with 46/6196 days in the usual care group (relative risk 0.32 [CI 95% 0.19-0.55]). There were no significant differences in rehospitalizations, mortality, or disease-specific quality of life between groups. CONCLUSIONS: A pharmacy-led intervention can improve medication compliance in patients with moderate to severe heart failure, even in those with relatively high compliance. Future interventions should also focus at less compliant patients.
Aged↗
Effects of NSAIDs on the incidence of hospitalisations for renal dysfunction in users of ACE inhibitors.
INTRODUCTION: Although relatively safe, both NSAIDs and ACE inhibitors can cause renal dysfunction in patients with compromised renal function. Case reports indicate that the combined use of ACE inhibitors and NSAIDs increases the risk of renal dysfunction. It is not known how often and when renal dysfunction occurs in patients using a combination of ACE inhibitors and NSAIDs. OBJECTIVE: The objective of the study was to investigate the effects of NSAIDs on the incidence of hospitalisations due to renal dysfunction in patients treated with ACE inhibitors. STUDY DESIGN: Case-control study nested within a cohort of users of ACE inhibitors. PARTICIPANTS: All participants had at least two consecutive prescriptions for an ACE inhibitor. One hundred and forty-four cases were admitted to hospital for renal insufficiency during use of ACE inhibitors. There were 1189 randomly sampled control patients who did not have any hospital admission for renal dysfunction during use of ACE inhibitors. MAIN OUTCOME MEASURES: The risk for hospitalisation for renal dysfunction associated with exposure to NSAIDs in patients receiving ACE inhibitors was expressed as odds ratios (OR). RESULTS: Of 144 cases, a total of 32 (22.2%) received NSAIDs in the 90 days before hospital admission for renal dysfunction. Recent start (<90 days) of an NSAID was associated with an increased risk of admission for renal dysfunction (adjusted OR 2.2; 95% CI 1.1-4.5). The increased risk was most pronounced in patients aged >70 years (adjusted OR 2.7; 95% CI 1.0-7.2). For patients who started NSAIDs and were dispensed at least three prescriptions in the 90 days preceding hospitalisation an adjusted OR of 7.1 (95% CI 1.8-28.7) was observed. CONCLUSIONS: This study strongly suggests an increased risk for hospitalisation for renal insufficiency in patients receiving ACE inhibitors who start using NSAIDs. Elderly patients receiving several prescriptions for NSAIDs in a short period of time are particularly at risk. Renal function should be closely monitored in these patients.
Adult↗
Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: the Rotterdam Study.
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with first hospitalization for congestive heart failure (CHF). It is likely, however, that NSAIDs precipitate a relapse but are less likely to induce a first occurrence of (incident) heart failure. METHODS: A total of 7277 participants in the Rotterdam Study were followed up from the interview date until the first of the following events: a diagnosis of incident heart failure, death, removal, or end of the follow-up period. Excluded from the study population were all participants with prevalent heart failure at baseline. Exposure to NSAIDs and other medication was calculated on the basis of automated data on filled drug prescriptions in the pharmacies within the study area. In a second analysis, we followed up all participants with incident heart failure until the first relapse or the end of follow-up. RESULTS: Incident heart failure was encountered in 345 participants during follow-up. Current use of NSAIDs was associated with a relative risk of incident heart failure of 1.1 (95% confidence interval [CI], 0.7-1.7), after adjustment for age, sex, and concomitant medication. In patients with prevalent heart failure who filled at least 1 NSAID prescription since diagnosis of heart failure, the univariate and adjusted relative risks of a relapse were 3.8 (95% CI, 1.1-12.7) and 9.9 (95% CI, 1.7-57.0), respectively. CONCLUSIONS: The use of NSAIDs is not associated with an increased risk of incident heart failure. In patients with prevalent heart failure, current use of NSAIDs is associated with a substantially increased risk of a relapse.
Aged↗
Changes in prescribed drug doses after market introduction.
PURPOSE: The establishment of recommended dosing regimens has always been a difficult aspect of drug development. This paper examines the extent to which postmarketing prescribing deviates from initially recommended dosing regimens. We used the World Health Organization's (WHO) periodically updated compilation of the 'Defined Daily Dose' (DDD) to reflect prevailing patterns of prescribing in national markets. The aim of this study was to evaluate DDD changes over time (1982-2000) and to identify possible determinants of these changes. METHODS: Data on DDD changes were obtained from the WHO's Oslo Collaborating Centre. We performed a case-control analysis in which we compared drugs with (cases) and without (controls) postmarketing changes in DDD on possible determinants associated with DDD change. RESULTS: We found 115 instances of a change of DDD in the period 1982-2000 (45 (39.1%) increases and 70 (60.9%) decreases). Antibiotics showed the greatest number of changes in DDD: predominantly increases in the 1980s, while the 1990s were dominated by decreases in DDD of mostly cardiovascular drugs. CONCLUSION: Changes in DDD reflect the outcome of a melange of forces, including misconceptions of dose requirements during pre-market development of drug and postmarketing changes in pharmacotherapeutic knowledge, clinical concepts, economic forces, and, in the case of anti-infective agents, changing patterns of resistance/sensitivity of target microorganisms to the anti-infective agent(s) in question.
Anti-Bacterial Agents↗
Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands.
PURPOSE: To evaluate the safety profile of sertraline versus other Selective Serotonin Reuptake Inhibitors (SSRIs) directly following the introduction of sertraline to the Dutch market. METHODS: In a prospective follow-up study, 109 psychiatrists included patients with a new episode of treatment with sertraline and an equal number of patients starting treatment with other SSRIs. All Adverse Events (AEs) during follow-up were recorded by the psychiatrists for the duration of SSRI treatment until discontinuation or until at least 12 months. RESULTS: A total of 1251 patients were included in the study of which 659 used sertraline and 592 used other SSRIs (paroxetine, fluoxetine or fluvoxamine). The most frequently reported events in sertraline users and users of other SSRIs were nausea (160 (24.3%) sertraline patients versus 160 (27.0%) patients using other SSRIs), headache (127 (19.3%) sertraline patients versus 101 (17.1%) patients using other SSRIs), diarrhoea (94 (14.0%) sertraline patients versus 40 patients using other SSRIs (6.8%, p < 0.05)), sweating (88 (13.4%) sertraline patients versus 69 (11.7%) patients using other SSRIs) and dizziness (75 (11.4%) sertraline patients versus 70 (11.8%) patients using other SSRIs). A total of 121 patients reported 134 different unlabelled AEs of which 10 were reported by more than 1% of the population. CONCLUSIONS: In this study we found that almost three out of four patients reported an adverse event. When comparing with other SSRIs and the literature, we found a similar distribution of the most frequently reported adverse events in patients using sertraline. However, in this observational study we found over 100 different unlabelled adverse events.
Adolescent↗
Characteristics of diarrhoea in 10,008 users of lansoprazole in daily practice: which co-factors contribute?
PURPOSE: Diarrhoea is one of the most frequently reported adverse events during proton pump inhibitor use in any setting. Because of the limited available information, this study was set up with the aim of assessing the incidence and characteristics of diarrhoea and to investigate possible associated co-factors in proton pump inhibitor users in daily practice. METHODS: Data were used from a prospective, observational study in which 10,008 lansprazole users were followed over time (1994-1998). The study was designed according to the SAMM guidelines. A nested case-control design was used to compare proton pump inhibitor users reporting diarrhoea with those reporting no diarrhoea. RESULTS: The frequency of diarrhoea was 3.7% and the incidence density 10.7 per 1000 patients months of proton pump inhibitor use. The diarrhoea was most commonly loose and occurred on average 4.4 times per day. The analysis of co-factors revealed that patients with concomitant use of oral antibiotics and patients reporting neurological and/or dermatological adverse events, were at risk of developing diarrhoea during proton pomp inhibitor use. CONCLUSIONS: In conclusion, diarrhoea was as frequently reported in our study as in clinical trials and observational data of lansoprazole users. We found the concomitant use of oral antibiotics and the reporting of certain other adverse events to be associated with the reporting of diarrhoea during lansoprazole use. Although a relationship with the proton pump inhibitor intake seemed very plausible, we recommend that use of concomitant medicines as a cause of diarrhoea must be taken into consideration in lansoprazole users.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Is sexual dysfunctioning a reason for discontinuation in users of selective serotonin reuptake inhibitors?
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Adult↗