Bordson Sophie J, Atayee Rabia S, Ma Joseph D, Best Brookie M
Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego (UC San Diego), La Jolla, California, USA.
Pain Med. 2014 Mar;15(3):355-63. doi: 10.1111/pme.12300. Epub 2013 Dec 5.
Tricyclic antidepressants (TCAs) are first-line treatment for neuropathic pain. Despite widespread use, many health care providers do not know which patients are currently taking TCAs. The objective of this retrospective data analysis was to determine adherence rates to amitriptyline, nortriptyline, or imipramine. The rate at which patients used TCAs (confirmed by presence of TCA in the urine) but did not inform their health care provider is also reported (non-informed prescriber rate). Finally, the effects of age, sex, and number of prescriptions on adherence and non-informed prescriber rates were assessed.
Urinary excretion data were obtained from 55,296 patients with pain and were analyzed using liquid chromatography tandem mass spectrometry in a multiplex assay which included amitriptyline, nortriptyline, and imipramine.
The adherence rate was 66% (1,407/2,137); the rate of non-informed prescribers was 3% (1,547/55,296) among the general population, and 52% (1,547/2,954) when only TCA users were considered. While adherence was higher among older and female subjects, the number of other medications did not affect adherence rate.
This analysis reveals that many prescribers are not informed when patients start and stop using TCAs.
三环类抗抑郁药（TCAs）是治疗神经性疼痛的一线药物。尽管其使用广泛，但许多医疗服务提供者并不清楚哪些患者正在服用TCAs。本回顾性数据分析的目的是确定患者对阿米替林、去甲替林或丙咪嗪的依从率。同时报告患者使用TCAs（通过尿液中存在TCAs确认）但未告知其医疗服务提供者的比例（未告知开处方者比例）。最后，评估年龄、性别和处方数量对依从率和未告知开处方者比例的影响。
从55296名疼痛患者中获取尿液排泄数据，并使用液相色谱串联质谱法在一项包括阿米替林、去甲替林和丙咪嗪的多重检测中进行分析。
依从率为66%（1407/2137）；在普通人群中，未告知开处方者的比例为3%（1547/55296），仅考虑使用TCAs的患者时，该比例为52%（1547/2954）。虽然老年和女性受试者的依从性较高，但其他药物的数量并不影响依从率。
该分析表明，当患者开始和停止使用TCAs时，许多开处方者并未得到通知。
