gms | German Medical Science

23. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

24.11. - 25.11.2016, Bochum

Prescription Patterns of Drugs Prolonging the QT – Interval Relating to Patients Receiving Maintenance Therapy

Meeting Abstract

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  • corresponding author presenting/speaker Heike Voss - Medizinischer Dienst der Krankenversicherung Nord, Hamburg, Germany
  • author Marc Heidbreder - Medizinischer Dienst der Krankenversicherung Nord, Hamburg, Germany
  • author Reinhard Schuster - Medizinischer Dienst der Krankenversicherung Nord, Hamburg, Germany
  • author Timo Emcke - Kassenärztliche Vereinigung Schleswig-Holstein, Bad Segeberg, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 23. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bochum, 24.-25.11.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16gaa07

doi: 10.3205/16gaa07, urn:nbn:de:0183-16gaa072

Veröffentlicht: 23. November 2016

© 2016 Voss et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background: Maintenance therapy has been found to be an effective treatment for opioid use disorder. In Germany, the most commonly applied drugs are racemic methadone and levomethadone that both are known to prolong the corrected QT (QTc) interval. QT prolongation is due to an extended action potential and concurrent aberrations of repolarization, resulting in potential life-threatening cardiac arrhythmias like polymorphic ventricular tachycardia. In this context it is noteworthy that the number of elderly patients receiving maintenance therapy is continuously growing over time. In addition, this patient clientele frequently is suffering from various comorbidities. Hence, we analyzed numbers of prescriptions of additional drugs especially of those bearing a potential to prolong QTc to patients receiving methadone or levomethadone, respectively.

Materials and Methods: We analyzed prescription data of the statuatory health insurance in the federal state Schleswig-Holstein with focus on methadone / levomethadone in 2014 and consideration of the corresponding age groups of patients receiving maintenance therapy. Furthermore, prescriptions patterns of additionally prescribed drugs potentially prolonging cQT were analyzed. For this purpose, prescribed drugs were categorized by applying the Anatomical Therapeutic Chemical Classification (ATC) System. Regarding the potential of prolonging QTc, prescribed drugs were further divided in 3 groups (drugs to avoid / possible risk / conditional risk) based on the lists provided by the ‚Arizona Center for Education and Research on Therapeutics‘ (AzCERT).

Results: Overall, 4611 prescriptions in 2014 were analyzed further. 2538 patients continuously received methadone and 2073 patients levomethadone, respectively. Drugs with a possible risk of prolonging QTc were prescribed to 5.1% of the patients. 1.7% of patients additionally received drugs recommended to be avoided in combination with methadone / levomethadone. Additionally prescribed drugs comprised mainly psychotropic drugs and antibiotics. Highest numbers of prescriptions applied to the gyrase inhibitor ciprofloxacin and the antidepressant drug citalopram. Regarding the age of patients, the highest number of prescriptions was observed in the group of patients 35 up to 45 years old. In addition, 4.4% of patients received drugs belonging to the group with a conditional risk to prolong QTc. Again, psychotropic drugs were found to be prescribed most frequently especially the antipsychotic quetiapine and the antidepressant mirtazapine. In this group, prescriptions of antibiotics were found to be irrelevant. Highest numbers of prescriptions were again observed in the group comprising patients in the age 35 up to 45 years.

Conclusion: Drugs prolonging QTc bear a proven risk for inducing cardiac arrhythmias regarding patients receiving methadone / levomethadone in the context of a maintenance therapy. Overall, analysis of prescription data revealed that 5.1% of patients additionally received those drugs especially psychotropic drugs. This may be explained by the fact that patients undergoing maintenance therapy often suffer from various psychic comorbidities. In most cases, drugs bearing a possible or conditional risk of prolonging QTc were prescribed indicating a responsible manner regarding prescription of these drugs.


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