Article
Effect of direct healthcare professional communications on prescribing behaviour
Effekt von Rote-Hand-Briefen auf das Verschreibungsverhalten
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Authors
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Ursula Köberle
- Bundesärztekammer, Bereich Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Germany
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Renate Grohmann
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Germany
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Michael Belz
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Germany
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Waldemar Greil
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Germany
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Ursula Gundert-Remy
- Bundesärztekammer, Bereich Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Germany
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Detlef Degner
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Germany
| Published: | November 21, 2022 |
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Outline
Text
Background: The aim of this study was to analyze the effect of the direct healthcare professional communications (DHPC) on citalopram and escitalopram on prescribing behaviour in inpatients with anxiety disorders.
The US Food and Drug Administration informed on the dose dependent QTc-prolonging effect of citalopram in 2011 [1]. Shortly after, DHPC on citalopram and escitalopram restricted their use in Germany. The restrictions indicated a reduced maximum daily dose and a contraindication regarding QTc-prolonging co-medication [2], [3].
Materials and Methods: We used drug utilization data from the project “Arzneimittelsicherheit in der Psychiatrie e.V.” (AMSP). In this multicenter pharmacovigilance project adverse drug reactions of psychotropics are documented in inpatients. On two yearly reference dates, drug utilization data is recorded in the participating psychiatric hospitals [4]. Data on citalopram and escitalopram use from pre-DHPC (2004-2010) and data from post-DHPC (2013-2017) were compared with respect to 1) the proportion of patients exceeding the newly recommended maximum daily dose (“high dose”) of citalopram or escitalopram and 2) the proportion of patients treated with QTc-prolonging co-medication (according to the German summary of product characteristics). Patients aged 18 years and older who had been hospitalized for anxiety disorders and treated with citalopram or escitalopram were included in this analysis. For each patient, dosage and concomitant medication were reviewed. Citalopram and escitalopram were evaluated in a combined analysis.
Results: We included 364 patients with anxiety disorders treated with citalopram or escitalopram pre-DHPC, and 262 patients post-DHPC. Demographic data were similar pre- and post-DHPC. The proportion of high-dose-patients declined from 10.7 to 5.4% (p=0.019) whereas the proportion of patients with QTc-prolonging co-medication did not change (54.7 vs. 51.5%, p=0,437).
Conclusion: In this study in inpatients with anxiety disorders, a decrease was found in dose but not in QTc-prolonging co-medication. This is in line with the results of previous studies with heterogenous populations [5], [6], [7], [8]. The straightforward instructions on the reduced maximum daily dose seem to be easier to be followed than the more complex new contraindication concerning any co-medication with QTc-prolonging drugs. Information on drug risks such as DHPC should be formulated as clearly as possible. Advice for specific clinical situations might facilitate the implementation of new instructions on the safe use of medicines.
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