All Wales Therapeutics and Toxicology Centre, University Hospital Llandough, Llandough, UK.
School of Medicine, Cardiff University, Cardiff, UK.
Br J Clin Pharmacol. 2023 Dec;89(12):3596-3605. doi: 10.1111/bcp.15840. Epub 2023 Aug 13.
Limiting use of the antidepressant dosulepin has been encouraged due to associated risks of toxicity. In April 2011, the All Wales Medicines Strategy Group introduced a National Prescribing Indicator (NPI) to monitor dosulepin usage. The aim of this study was to investigate antidepressant prescribing patterns, and selected adverse events in patients prescribed dosulepin following introduction of the NPI.
An e-cohort study was conducted. Adult patients receiving regular dosulepin prescriptions between October 2010 and March 2011 were included. Characteristics of patients who were continued on dosulepin, were switched to an alternative antidepressant or whose dosulepin was discontinued following introduction of the NPI were compared.
In total, 4121 patients were included. Of these, 1947 (47%) continued dosulepin, 1487 (36%) were switched and 692 (17%) discontinued. Of the 692 who discontinued, 92% did not receive a prescription for another antidepressant during the follow-up period. Patients whose dosulepin was discontinued were older and were less commonly coprescribed benzodiazepines. During follow-up, recorded incidence of selected adverse events was low across all groups and no significant difference was observed.
Over half of patients had discontinued dosulepin at the end of the period when the NPI was in place. Further interventions may have been required to have a greater impact on prescribing. This study provides some reassurance that dosulepin discontinuation can be a successful strategy, and that the risk of the adverse events investigated was unlikely to have been greater in those who had dosulepin discontinued than in those in whom dosulepin had been continued.
由于与毒性相关的风险，已鼓励限制使用抗抑郁药多虑平。2011 年 4 月，全威尔士药物策略小组引入了国家处方指标（NPI）来监测多虑平的使用情况。本研究旨在调查在引入 NPI 后开处多虑平的患者的抗抑郁药处方模式和选定的不良事件。
进行了电子队列研究。纳入 2010 年 10 月至 2011 年 3 月期间定期接受多虑平处方的成年患者。比较了在引入 NPI 后继续使用多虑平、改用其他抗抑郁药或停用多虑平的患者的特征。
共纳入 4121 例患者。其中，1947 例（47%）继续使用多虑平，1487 例（36%）被换用，692 例（17%）停药。在停用多虑平的 692 例患者中，92%在随访期间未开处另一种抗抑郁药。停药患者年龄较大，合并使用苯二氮䓬类药物的情况较少。在随访期间，所有组的选定不良事件发生率均较低，未观察到显著差异。
在 NPI 实施期间结束时，超过一半的患者已停用多虑平。可能需要进一步干预才能对处方产生更大影响。本研究提供了一些保证，即停用多虑平可能是一种成功的策略，并且与继续使用多虑平的患者相比，停用多虑平的患者发生所调查的不良事件的风险不太可能更高。
