Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Department of Pharmacy, Phayamengrai Hospital, Chiang Rai, Thailand.
J Clin Pharm Ther. 2021 Oct;46(5):1274-1280. doi: 10.1111/jcpt.13423. Epub 2021 Mar 25.
Delirium is more common and life-threatening among the elderly. Currently, no other medications, including antipsychotics, have been approved for delirium. The number of practice guidelines recommends antipsychotics to be the first option among selected patients. This study aimed to identify the type of drug-related problems (DRPs) concerning antipsychotics use among elderly patients with delirium.
A retrospective observational study was conducted by collecting data from 2013 to 2016 in Maharaj Nakorn Chiang Mai Hospital, Thailand. Inpatients who were 60 years and over, diagnosed with delirium by ICD-10 diseases coding F05.X and treated with antipsychotics for delirium were included. A modified version of the American Society of Hospital Pharmacists classification criteria (mASHP-delirium) was used.
A total of 379 patients were enrolled. Mean daily dose of haloperidol (oral) was 1.06 ± 1.33 mg, haloperidol (intramuscular) 2.71 ± 1.88 mg, haloperidol (intravenous; IV) 3.42 ± 1.97 mg, risperidone was 0.71 ± 0.52 mg, and quetiapine was 19.26 ± 15.63 mg. Among all, 427 events were classified as DRPs. The most common DRPs included inappropriate duration, dose, route of administration or dosage form accounting for the 416 events (97.4%), followed by actual adverse drug reactions (extrapyramidal symptoms; EPS), 6 events (1.4%) and potential drug-drug interactions for 5 events (1.2%). Of those 416 events, 200 events (48.1%) antipsychotics were continued after discharge and continued for more than 10 days. Dosage exceeding initial dose or maximum daily dose accounted for 179 events (43.0%). Other DRPs such as inappropriate route haloperidol IV and receiving the extended-release dosage form of quetiapine involve 26 (6.3%) and 11 (2.6%) events, respectively.
To the best of our knowledge, this is the first study using mASHP-delirium to identify DRPs of antipsychotics in treating delirium among elderly patients. Several DRPs were found that might lead to severe adverse drug reactions, particularly EPS and QTc interval prolongation. However, all DRPs could be prevented by developing antipsychotic setting protocols and specialty consulting systems to communicate among healthcare providers caring for vulnerable groups of patients. In addition, a prospective pharmacist intervention is required.
谵妄在老年人中更为常见且危及生命。目前，尚无其他药物（包括抗精神病药）被批准用于治疗谵妄。许多实践指南建议将抗精神病药作为选定患者的首选药物。本研究旨在确定与使用抗精神病药治疗老年谵妄患者相关的药物相关问题 (DRP) 的类型。
这是一项回顾性观察性研究，通过收集 2013 年至 2016 年泰国玛哈沙拉堪清迈医院的数据进行。纳入年龄在 60 岁及以上、通过 ICD-10 疾病编码 F05.X 诊断为谵妄且接受抗精神病药治疗谵妄的住院患者。使用改良版美国医院药剂师学会分类标准 (mASHP-delirium)。
共纳入 379 例患者。氟哌啶醇（口服）的平均日剂量为 1.06±1.33mg，氟哌啶醇（肌内注射）2.71±1.88mg，氟哌啶醇（静脉注射；IV）3.42±1.97mg，利培酮为 0.71±0.52mg，和喹硫平为 19.26±15.63mg。在所有患者中，共分类出 427 起药物相关问题。最常见的药物相关问题包括不适当的持续时间、剂量、给药途径或剂型，占 416 起（97.4%），其次是实际的药物不良反应（锥体外系症状；EPS），占 6 起（1.4%），药物-药物相互作用占 5 起（1.2%）。在这 416 起事件中，200 起（48.1%）抗精神病药在出院后继续使用且使用时间超过 10 天。剂量超过初始剂量或最大日剂量占 179 起（43.0%）。其他药物相关问题，如氟哌啶醇 IV 的不适当给药途径和使用喹硫平的延长释放剂型，分别涉及 26 起（6.3%）和 11 起（2.6%）事件。
据我们所知，这是第一项使用 mASHP-delirium 来确定治疗老年谵妄患者时抗精神病药药物相关问题的研究。发现了一些可能导致严重药物不良反应的药物相关问题，特别是 EPS 和 QTc 间期延长。然而，通过制定抗精神病药设置方案和专业咨询系统在照顾弱势群体的医疗保健提供者之间进行沟通，可以预防所有药物相关问题。此外，还需要进行前瞻性药师干预。
