Kriner Paul, Severus Emanuel, Korbmacher Julie, Mußmann Lisa, Seemueller Florian
Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Auenstrasse 6, 82467, Garmisch-Partenkirchen, Germany.
Asklepios Klinik Nord Psychiatrie Ochsenzoll, Langenhorner Chaussee 560, 22419, Hamburg, Germany.
Int J Bipolar Disord. 2023 Dec 19;11(1):40. doi: 10.1186/s40345-023-00323-6.
Lithium (Li) remains one of the most valuable treatment options for mood disorders. However, current knowledge about prescription practices in Germany is limited. The objective of this study is to estimate the prevalence of current Li use over time and in selected diagnoses, highlighting clinically relevant aspects such as prescription rates in elderly patients, concomitant medications, important drug-drug interactions, and serious adverse events.
We conducted a descriptive analysis of Li prescriptions, analyzing data from the ongoing Bavarian multicenter drug safety project Pharmaco-Epidemiology and Vigilance (Pharmako-EpiVig) from the years 2014-2021. Our study included 97,422 inpatients, 4543 of whom were prescribed Li.
The Li prescription rate in unipolar depression (UD) remained constant at 4.6% over the observational period. In bipolar disorder (BD), the prescription rate increased significantly from 28.8% in 2014 to 34.4% in 2019. Furthermore, 30.3% of patients with Li prescriptions did not have a diagnosis of BD or UD, and 15.3% of patients with schizoaffective disorder were prescribed Li. The majority (64%) of patients with Li prescriptions were prescribed five or more drugs. Most of the 178 high-priority drug-drug interactions were due to hydrochlorothiazide (N = 157) followed by olmesartan (N = 16).
Our study does not substantiate concerns about a decline in Li prescription. The decline in prescription rates observed in some diagnostic groups in 2020 and 2021 may be associated with the COVID-19 pandemic. The symptom-oriented use of Li beyond BD and UD is common. Polypharmacy and drug-drug interactions present a challenge in Li therapy. Old age and comorbid substance use disorder do not appear to be major deterrents for clinicians to initiate Li therapy.
锂（Li）仍然是治疗情绪障碍最有价值的选择之一。然而，目前关于德国处方实践的知识有限。本研究的目的是估计随时间推移以及在特定诊断中当前锂使用的患病率，突出临床相关方面，如老年患者的处方率、合并用药、重要的药物相互作用以及严重不良事件。
我们对锂处方进行了描述性分析，分析了2014年至2021年正在进行的巴伐利亚多中心药物安全项目药物流行病学与警戒（Pharmako-EpiVig）的数据。我们的研究包括97422名住院患者，其中4543人被开具了锂处方。
在观察期内，单相抑郁症（UD）的锂处方率保持在4.6%不变。在双相情感障碍（BD）中，处方率从2014年的二十八点八%显著增加到2019年的三十四点四%。此外，30.3%开具锂处方的患者没有BD或UD的诊断，15.3%的分裂情感性障碍患者被开具了锂处方。大多数（64%）开具锂处方的患者被开具了五种或更多药物。178种高优先级药物相互作用中的大多数是由氢氯噻嗪（N = 157）引起的，其次是奥美沙坦（N = 16）。
我们的研究没有证实对锂处方下降的担忧。2020年和2021年在一些诊断组中观察到的处方率下降可能与新冠疫情有关。锂在BD和UD之外以症状为导向的使用很常见。联合用药和药物相互作用在锂治疗中构成挑战。老年和合并物质使用障碍似乎并不是临床医生开始锂治疗的主要阻碍。
