scholarly journals Antipsychotic Polypharmacy and Adverse Drug Reactions Among Adults in a London Mental Health Service, 2008-2018

2021 ◽  
Author(s):  
Justin C Yang ◽  
Johan H Thygesen ◽  
Nomi Werbeloff ◽  
Joseph F Hayes ◽  
David P.J. Osborn
Keyword(s):  
Adverse Drug Reactions ◽  
Odds Ratio ◽  
Qt Interval ◽  
Adjusted Odds Ratio ◽  
Drug Reactions ◽  
Interval Prolongation ◽  
Real World Data ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
The Relationship

Background: Antipsychotic polypharmacy (APP) occurs commonly but it is unclear whether it is associated with an increased risk of adverse drug reactions. Electronic health records (EHRs) offer an opportunity to examine APP using real-world data. In this study, we use EHR data to identify periods when patients were prescribed 2+ antipsychotics and compare these with periods of antipsychotic monotherapy. To determine the relationship between APP and subsequent instances of adverse drug reactions: QT interval prolongation, hyperprolactinaemia, and increased body weight (body mass index [BMI] > 25). Methods: We extracted anonymised EHR data. Patients aged 16+ receiving antipsychotic medication at Camden & Islington NHS Foundation Trust between 1 January 2008 and 31 December 2018 were included. Multilevel mixed-effects logistic regression models were used to elucidate the relationship between APP and the subsequent presence of QT interval prolongation, hyperprolactinaemia, and/or increased BMI following a period of APP within 7, 30, or 180 days respectively. Results: We identified 35,409 observations of antipsychotic prescribing among 13,391 patients. APP was associated with a subsequent increased risk of hyperprolactinaemia (adjusted odds ratio 2.46; 95% C.I. 1.87-3.24) and of having a BMI > 25 (adjusted odds ratio 1.75; 95% C.I. 1.33-2.31) in the period following the APP prescribing. Conclusions: Our observations suggest that APP should be carefully managed with attention to hyperprolactinaemia and obesity.

Cetirizine-Induced Anaphylaxis; Celecoxib-Associated Anaphylaxis; Levetiracetam-Induced Pancytopenia; Trismus Induced by Fluoxetine; Aliskiren-Induced QT Interval Prolongation; Intestinal Necrosis Resulting from Sodium Polystyrene Sulfonate

2009 ◽  
Vol 44 (8) ◽  
pp. 658-661 ◽  
Author(s):  
Joel Shuster
Keyword(s):  
Adverse Drug Reactions ◽  
Qt Interval ◽  
Sodium Polystyrene Sulfonate ◽  
Polystyrene Sulfonate ◽  
Drug Reactions ◽  
Interval Prolongation ◽  
Intestinal Necrosis ◽  
Qt Interval Prolongation ◽  
The Us

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.

Abstract 12824: Higher Prevalence of Qt Interval Prolongation in Infants With Intrauterine Tobacco Smoke Exposure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kenji Harada ◽  
Yukiko Harada
Keyword(s):  
Confidence Interval ◽  
Tobacco Smoke ◽  
Odds Ratio ◽  
Qt Interval ◽  
Early Infancy ◽  
Interval Prolongation ◽  
Total Study Population ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
The Mean

Background: The association between QT interval prolongation and sudden infant death syndrome (SIDS) has been clearly established. Environmental tobacco smoke (ETS) exposure is also associated with increased risk for SIDS. However, there has been little focus on the relationship between the QT interval and ETS exposure during early infancy. To clarify this, we examined the QT interval with ETS exposure during early infancy. Methods: A total of 2168 infants (age:1-4 months), 743 infants who have been exposed to tobacco smoking since intrauterine life and 1425 age-matched children without ETS exposure, underwent electrocardiographic study. QT data were extracted from the electrocardiogram monitor built-in echocardiogram. The QT interval was measured on the first, second, third, and fourth month. The corrected QT interval (QTc) was calculated by dividing the QT interval by the square root of the RR interval (Bazett’s formula). QT interval prolongation was defined as QTc≧440 msec. The data of the number of cigarettes per day were collected by a questionnaire. Results: In the total study population, the mean QTc in ETS infants was significantly greater than in infants without ETS (402±21 and 395±20 msec, p<0.01). The absolute risk of QT prolongation was 1.11 % (16/1425) in infants without ETS; by contrast, that of ETS infants with QTc≧440 msec was 3.23% (24/743) (odds ratio, 2.94; 95% confidence interval, 2.30 to 3.58). The mean QTc in ETS infants at the first, second and third month was significantly greater than that in infants without ETS (404±20 vs. 397±21 msec, 407±19 vs. 399 ±17 msec and 404±17 vs. 390±18 msec, p < 0.01, respectively), but the mean QTc at the fourth month was similar in the 2 groups. The odds ratios for QTc≧440msec in ETS infants at the second and third month were 7.15 (95% confidence interval, 6.00 to 8.29) and 4.97 (95% confidence interval, 2.74 to 7.18), respectively. Compared with infants without ETS, ETS infants with the number of cigarettes ≧10 cigarettes per day had a significantly higher risk of QTc≧440 msec(odds ratio: 3.32, 95% confidence interval: 2.67-3.99). Conclusions: The present study indicates that environmental tobacco exposure is a risk for QT interval prolongation ≧440msec during early infancy.

Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Benjamin R Kummer ◽  
Rebecca Hazan ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Joshua Z Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Odds Ratio ◽  
Postoperative Infection ◽  
Adjusted Odds Ratio ◽  
Risk Of Infection ◽  
Postoperative Stroke ◽  
Increased Risk ◽  
Increase Risk ◽  
Initiative Program ◽  
The Relationship

Introduction: Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database. Hypothesis: Postoperative infection is associated with an increased risk of postoperative stroke. Methods: We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke. Results: 729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke. Conclusions: We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.

scholarly journals Drug-induced QT interval prolongation in cancer patients

2011 ◽  
Vol 4 (4) ◽  
pp. 223
Author(s):  
Torben K. Becker ◽  
Sai-Ching J. Yeung
Keyword(s):  
Cancer Patients ◽  
Qt Interval ◽  
Alkylating Agents ◽  
Torsade De Pointes ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Vascular Disruption ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Multiple Drugs

Cancer patients are at an increased risk for QT interval prolongation and subsequent potentially fatal Torsade de pointes tachycardia due to the multiple drugs used for treatment of malignancies and the associated symptoms and complications. Based on a systematic review of the literature, this article analyzes the risk for prolongation of the QT interval with antineoplastic agents and commonly used concomitant drugs. This includes anthracyclines, fluorouracil, alkylating agents, and new molecularly targeted therapeutics, such as vascular disruption agents. Medications used in the supportive care can also prolong QT intervals, such as methadone, 5-HT3-antagonists and antihistamines, some antibiotics, antifungals, and antivirals. We describe the presumed mechanism of QT interval prolongation, drug-specific considerations, as well as important clinical interactions. Multiple risk factors and drug–drug interactions increase this risk for dangerous arrhythmias. We propose a systematic approach to evaluate cancer patients for the risk of QT interval prolongation and how to prevent adverse effects.

scholarly journals Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death

2009 ◽  
Vol 160 (6) ◽  
pp. 985-991 ◽  
Author(s):  
N Benhadi ◽  
W M Wiersinga ◽  
J B Reitsma ◽  
T G M Vrijkotte ◽  
G J Bonsel
Keyword(s):  
Odds Ratio ◽  
Neonatal Death ◽  
Thyroid Dysfunction ◽  
Adjusted Odds Ratio ◽  
Thyroid Peroxidase ◽  
Child Loss ◽  
Increased Risk ◽  
The Mean ◽  
The Relationship ◽  
Tsh Levels

BackgroundTo examine the relationship between maternal TSH and free thyroxine (FT4) concentrations in early pregnancy and the risk of miscarriage, fetal or neonatal death.MethodCohort study of 2497 Dutch women. TSH, FT4, and thyroid peroxidase antibodies concentrations were determined at first booking. Child loss was operationalized as miscarriage, fetal or neonatal death. Women with overt thyroid dysfunction were excluded.ResultsTwenty-seven cases of child loss were observed. The mean TSH and FT4level in the women with child loss was 1.48 mU/l and 9.82 pmol/l compared with 1.11 mU/l and 9.58 pmol/l in women without child loss. The incidence of child loss increased by 60% (OR=1.60 (95% confidence interval (CI): 1.04–2.47)) for every doubling in TSH concentration. This association remained after adjustment for smoking, age, parity, diabetes mellitus, hypertension, previous preterm deliveries, and previous preterm stillbirth/miscarriage (adjusted odds ratio=1.80 (95% CI: 1.07–3.03)). This was not true for FT4concentrations (OR=1.41 (95% CI: 0.21–9.40);P=0.724).ConclusionIn a cohort of pregnant women without overt thyroid dysfunction, the risk of child loss increased with higher levels of maternal TSH. Maternal FT4concentrations and child loss were not associated.

scholarly journals The QT long syndrome: clinical and diagnostic aspect

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Constantin Martiniuc ◽  
◽  
Serghei Pisarenco ◽  
Iurie Simionica ◽  
◽  
...  
Keyword(s):  
Qt Interval ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Current Data ◽  
Polymorphic Ventricular Tachycardia ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Wide Range ◽  
Life Threatening

QT interval prolongation is a predictor of the life-threatening cardiac arrhythmias — polymorphic ventricular tachycardia (torsade de pointes). Long QT syndrome may be congenital or acquired. It is known that a wide range of both antiarrhythmic and non-cardiac medications might lead to QT interval prolongation. List of drugs that cause QT prolongation is constantly growing and being updated. The review contains current data on the clinical significance of the control of QT interval duration within drug therapy. Clinical conditions associated with an increased risk of QT interval prolongation are described. Drugs that can induce QT prolongation are also discussed.

scholarly journals Сardiotoxicity of chloroquine and hydroxychloroquine in the treatment of COVID-19 infection

2020 ◽  
Vol 22 (10) ◽  
pp. 15-21
Author(s):  
Marina V. Leonova ◽  
◽  
◽  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Ventricular Arrhythmia ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Connective Tissue Diseases ◽  
World Health ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Increased Risk

The cardiotoxicity of aminoquinolines presents as QT interval prolongation and life-threatening ventricular arrhythmia, torsade de pointes (TdP). A scientific re-view of studies and meta-analyzes on the rate and risk of cardiotoxicity of aminoquinolines (chloroquine and hydroxychloroquine) is presented. The mechanism of development of QT syndrome during the use of aminoquinolines is associated with inhibition of the hERG gene open potassium channels 1A and 1A/1B, which are involved in the repolarization process, as well as inhibition of potassium, calcium and If-channels of the heart, which leads to an impaired conduction and bradycardia. In 3 systematic review of data (1962–2018) of analysis of cardiotoxic side effects of chloroquine, hydroxychloroquine, mefloquine in the treat-ment of malaria and connective tissue diseases, isolated cases of death due to QT interval prolongation/TdP arrhythmia were revealed, however, data on the rate of detecting QT interval prolongation was not enough. In the face of the COVID-19 novel coronavirus pandemic emergency, aminoquinolines are being re-purposed by the Food and Drug Administration – FDA (repurposing) to treat severe acute respiratory syndrome in hospitalized patients. Chloroquine and hy-droxychloroquine were intended to be administered in short courses with QT monitoring. However, the first data of clinical trials have revealed an increased risk for hospital mortality in patients with COVID-19. In the first systematic review of studies in COVID-19 (14 clinical trials, n=1515), a clinically significant QT interval prolongation (QT≥500 ms or change of more than 60 ms) in 10% of patients receiving chloroquine/hydroxychloroquine, and isolated cases of fatal arrhythmia was revealed. Subsequent studies showed that the incidence of QT interval prolongation during the use of chloroquine/hydroxychloroquine ranges from 10 to 23%, with isolated cases of ventricular arrhythmia TdP, but there is a significant increase in mortality (relative risk – RR 1.3–1.50) and sudden cardiac arrest (RR 1.91), especially in combination with azithromycin (RR>2.0). The FDA and the World Health Organization have limited the use of drugs for COVID-19. Perspectives for further treatment of COVID-19 infection are associated with remdesivir and favipiravir.

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