Abu-Naser Dania, Gharaibeh Sara, Al Meslamani Ahmad Z, Alefan Qais, Abunaser Renad
Department of Applied Sciences, Irbid University College, Al-Balqa' Applied University, Irbid, Jordan.
Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
Clin Pract Epidemiol Ment Health. 2021 Feb 16;17:1-7. doi: 10.2174/1745017902117010001. eCollection 2021.
Extrapyramidal Symptoms (EPS) are unwanted symptoms commonly originating from the use of certain medications. The symptoms can range from minimal discomfort to permanent involuntary muscular movements. The aims of the study were to examine the incidence of drug-induced extrapyramidal symptoms (di-EPS), associated risk factors, and clinical characteristics.
This is a retrospective, observational study of di-EPS conducted in outpatient clinics of Jordan using the longitudinal health database (Hakeem) for data collection. Patients who received drugs with the risk of EPS during the period 2010-2020 were included and followed. Patients with any of the known underlying conditions that may cause EPS or were currently taking drugs that may mask the symptoms were excluded. Gender and age-matched control subjects were included in the study. The Statistical Package for Social Science (SPSS) version 26 was used for data analysis.
The final dataset included 34898 exposed patients and 69796 matched controls. The incidence of di-EPS ranged from 9.8% [Amitriptyline 25mg] to 28.9% (Imipramine 25mg). Baseline factors associated with a significantly higher risk of developing di-EPS were age {HR: 1.1 [95%CI: 0.8-1.2, p=0.003], smoking {HR: 1.7 (95%CI: 1.3-2.2), p=0.02}, tremor history {HR: 7.4 (95%CI: 5.9-8.3), p=.002} and history of taking antipsychotics {HR: 3.9, (95% CI: 2.5-4.6), p=0.001}. Patients taking paroxetine {HR: 8.6 [95%CI: 7.4-9.8], p=.0002},imipramine {HR: 8.3, [7.1-10.5], p=0.01}, or fluoxetine {HR: 8.2 (95%CI: 6.8-9.3), p=.006} had a significantly higher risk of developing di-EPS compared to patients taking citalopram. Myoclonus, blepharospasm, symptoms of the basal ganglia dysfunction, and organic writers' cramp were reported among participants.
Patients treated with paroxetine, imipramine, fluoxetine, or clomipramine had a higher risk of developing di-EPS than patients treated with citalopram. The difference in gender was not significantly related to di-EPS development. Whereas age, smoking, and history of taking antipsychotics were significantly associated with di-EPS development.
• High incidence of drug-induced extrapyramidal symptoms (di-EPS) was reported• Age, smoking, tremor history, and history of taking antipsychotics were risk factors of drug-induced extrapyramidal symptoms.• Patients taking paroxetine, imipramine or fluoxetine had a significantly higher risk of developing di-EPS compared to patients taking citalopram.
锥体外系症状（EPS）是使用某些药物时常见的不良症状。这些症状的范围从轻微不适到永久性不自主肌肉运动。本研究的目的是检查药物性锥体外系症状（di-EPS）的发生率、相关危险因素和临床特征。
这是一项在约旦门诊诊所进行的关于di-EPS的回顾性观察研究，使用纵向健康数据库（哈基姆）进行数据收集。纳入并随访了2010年至2020年期间接受有EPS风险药物治疗的患者。排除患有任何可能导致EPS的已知基础疾病或正在服用可能掩盖症状药物的患者。研究纳入了性别和年龄匹配的对照对象。使用社会科学统计软件包（SPSS）26版进行数据分析。
最终数据集包括34898名暴露患者和69796名匹配对照。di-EPS的发生率从9.8%[阿米替林25毫克]到28.9%（丙咪嗪25毫克）不等。与发生di-EPS风险显著更高相关的基线因素包括年龄{风险比：1.1[95%置信区间：0.8 - 1.2，p = 0.003]}、吸烟{风险比：1.7（95%置信区间：1.3 - 2.2），p = 0.02}、震颤病史{风险比：7.4（95%置信区间：5.9 - 8.3），p = 0.002}和服用抗精神病药物史{风险比：3.9，（95%置信区间：2.5 - 4.6），p = 0.001}。与服用西酞普兰的患者相比，服用帕罗西汀{风险比：8.6[95%置信区间：7.4 - 9.8]，p = 0.0002}、丙咪嗪{风险比：8.3，[7.1 - 10.5]，p = 0.01}或氟西汀{风险比：8.2（95%置信区间：6.8 - 9.3），p = 0.006}的患者发生di-EPS的风险显著更高。参与者中报告了肌阵挛、眼睑痉挛、基底神经节功能障碍症状和有机书写痉挛。
与接受西酞普兰治疗的患者相比，接受帕罗西汀、丙咪嗪、氟西汀或氯米帕明治疗的患者发生di-EPS的风险更高。性别差异与di-EPS的发生无显著相关性。而年龄、吸烟和服用抗精神病药物史与di-EPS的发生显著相关。
•报告了药物性锥体外系症状（di-EPS）的高发生率。•年龄、吸烟、震颤病史和服用抗精神病药物史是药物性锥体外系症状的危险因素。•与服用西酞普兰的患者相比，服用帕罗西汀、丙咪嗪或氟西汀的患者发生di-EPS的风险显著更高。
