Pharmacy Service, Institut Guttmann, Neurorehabilitation Hospital, Camí de Can Ruti s/n, 08916, Badalona, Barcelona, Spain.
Neurorehabilitation Unit, Institut Guttmann, Neurorehabilitation Hospital, Camí de Can Ruti s/n, 08916, Badalona, Barcelona, Spain.
Eur J Clin Pharmacol. 2019 Jul;75(7):985-994. doi: 10.1007/s00228-019-02651-y. Epub 2019 Mar 5.
Patients who suffer acquired brain injury (ABI) require a great variety of drugs. Furthermore, the lack of evidence on the medication effects in this type of patient increases off-label prescription. The aim of this study was to describe the pattern of medication use and the practice of prescribing off-label drugs in these patients.
A cross-sectional study was conducted in patients with ABI, of either traumatic or non-traumatic cause, admitted to a neurorehabilitation hospital for rehabilitation. Demographic and clinical data and prevalence of medication use and off-label prescription were collected.
The majority of the studied patients (85.2%) were considered polymedicated since they were prescribed ≥ 6 drugs concomitantly. In traumatic brain injury (TBI) patients, antidepressants (81.5%) were the Anatomical Therapeutic Chemical (ATC) group's most prescribed versus antithrombotic agents (80.5%) in non-traumatic brain injury (N-TBI) patients. Up to 37.3% of all active substances prescribed in TBI patients were off-label compared with 24.9% in N-TBI patients. The most prescribed off-label active substances in both groups were those related to the Nervous System (N) ATC group to treat neurobehavioural problems.
A multidisciplinary pharmacotherapeutic follow-up of these patients would be essential to address the high prescription rate of medications and the off-label prescription practice. In this way, medication problems related to polypharmacy could be minimised and the benefit-risk ratio of prescribed off-label drugs could be ensured according to the available medical evidence.
患有获得性脑损伤（ABI）的患者需要使用多种药物。此外，由于缺乏此类患者药物效果的证据，导致了药物的超适应证使用。本研究旨在描述这类患者的用药模式和超适应证用药的情况。
对因创伤或非创伤原因入住神经康复医院进行康复治疗的 ABI 患者进行了一项横断面研究。收集了人口统计学和临床数据以及药物使用和超适应证处方的流行率。
大多数研究患者（85.2%）被认为是多药治疗的，因为他们同时服用了≥6 种药物。在创伤性脑损伤（TBI）患者中，抗抑郁药（81.5%）是使用最多的解剖治疗化学（ATC）组药物，而非创伤性脑损伤（N-TBI）患者则是抗血栓药物（80.5%）。TBI 患者中有高达 37.3%的活性物质被开为超适应证药物，而 N-TBI 患者中则有 24.9%。在两组患者中，使用最多的超适应证药物都是用于治疗神经行为问题的神经系统（N）ATC 组药物。
对这些患者进行多学科的药物治疗随访至关重要，这有助于解决药物高处方率和超适应证处方的问题。这样可以最小化与多药治疗相关的药物问题，并根据现有医疗证据确保处方超适应证药物的效益-风险比。
