Detail-View

Pharmacoepidemiological safety study of neuroleptics and antidepressants in the area of geriatric psychiatrics

Description

More than half of Germans aged 65 and older are treated with antipsychotics or antidepressants despite of concerns that the use of these drugs in this population is associated with an increase in adverse drug reactions (ADR) such as cerebrovascular events, cardiovascular diseases, pneumonia, fractures, venous thromboembolisms and mortality.

The aim of this project was the investigation of risks of mortality as well as frequencies and patterns of prescription of antipsychotics and antidepressants in elderly persons. The German Pharmacoepidemiological Research Database served as the data source for this project, which wasfunded by the German Federal Institute for Drugs and Medical Devices (BfArM).

Results of the project’s studies show that antipsychotics are frequently used “off-label” outside of their approved indications. Furthermore, very short treatment durations with antipsychotics indicate frequent “as needed” treatment. Antidepressant prescription patterns were found to be generally plausible. However, high prescription frequencies of tricyclic antidepressants were found which is concerning as these drugs should not be used in the elderly due to the anticholinergic and sedative properties.

An increased risk of mortality was observed for the antipsychotic drugs haloperidol, zuclopenthixol and melperone when compared with risperidone. Quetiapine, prothipendyl, olanzapine, tiapride, clozapine, perazine and flupentixol showed a lower risk for mortality when compared with risperidone. An increased risk of mortality for levopromazine and chlorprothixene was observed only in patients with dementia who were 80 years or older.

Funding period

Begin:   November 2012
End:   August 2015

Sponsor

  • Federal Institute for Drugs and Medical Devices

Contact

Dr. rer. medic. Tania Schink

Selected project-related publications

    Articles with peer-review

  • Jobski K, Schmedt N, Kollhorst B, Krappweis J, Schink T, Garbe E. Characteristics and drug use patterns of older antidepressant initiators in Germany. European Journal of Clinical Pharmacology. 2017;73(1):105-113.
    http://dx.doi.org/10.1007/s00228-016-2145-7
  • Schmedt N, Jobski K, Kollhorst B, Krappweis J, Schink T, Rüther E, Garbe E. Treatment patterns and characteristics of older antipsychotic users in Germany. International Clinical Psychopharmacology. 2016;31(3):159-169.
    http://dx.doi.org/10.1097/YIC.0000000000000119
  • Schmedt N, Kollhorst B, Enders D, Jobski K, Krappweis J, Garbe E, Schink T. Comparative risk of death in older adults treated with antipsychotics: A population-based cohort study. European Neuropsychopharmacology. 2016;26(9):1390-1400.
    http://dx.doi.org/10.1016/j.euroneuro.2016.07.006
  • Presentations at scientific meetings/conferences

  • Schmedt N, Kollhorst B, Jobski K, Schink T, Garbe E. Comparative risk of death among elderly users of antipsychotic drugs. 10. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi), 30. September-2. Oktober 2015, Potsdam.
  • Schmedt N, Kollhorst B, Jobski K, Schink T, Garbe E. Comparative risk of ischemic stroke among elderly users of antipsychotic drugs in Germany. 10. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi), 30. September-2. Oktober 2015, Potsdam.
  • Schmedt N, Kollhorst B, Jobski K, Schink T, Garbe E. Comparative risk of ischemic stroke among elderly users of antipsychotic drugs in Germany. International Society for Pharmacoepidemiology (ISPE) Mid-Year Meeting, 12-14 April 2015, Bordeaux, France.
  • Jobski K, Schmedt N, Schink T, Garbe E. Drug use patterns and characteristics of elderly users of antidepressants in Germany. 30th International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 24-27 October 2014, Taipei, Taiwan.
  • Schmedt N, Jobski K, Schink T, Garbe E. Drug use patterns of elderly neuroleptic users in Germany. 9. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi), 17.-20. September 2014, Ulm.
  • Schmedt N, Jobski K, Schink T, Garbe E. Neuroleptic and antidepressant use in the elderly German population. 9. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi), 17.-20. September 2014, Ulm.
  • Schmedt N, Jobski K, Schink T, Garbe E. Drug use patterns of elderly neuroleptic users in Germany. 21. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie, 20.-21. November 2014, Bonn.
  • Posters at scientific meetings/conferences

  • Kollhorst B, Jobski K, Schmedt N, Schink T, Garbe E. All-cause mortality among elderly users of antidepressant drugs in Germany. 31st International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 22-26 August 2015, Boston, USA. (Abstract published in: Pharmacoepidemiology and Drug Safety. 2015;24(Suppl. 1):329)
  • Schmedt N, Kollhorst B, Jobski K, Schink T, Garbe E. Comparative risk of death among elderly users of antipsychotic drugs. 31st International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 22-26 August 2015, Boston, USA. (Abstract published in: Pharmacoepidemiology and Drug Safety. 2015;24(Suppl. 1):329)
  • Schmedt N, Kollhorst B, Jobski K, Schink T, Garbe E. Comparative risk of venous thromboembolism among elderly users of antipsychotic drugs. 31st International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 22-26 August 2015, Boston, USA. (Abstract published in: Pharmacoepidemiology and Drug Safety. 2015;24(Suppl. 1):325)
  • Fassmer A, Schink T. Repräsentativität von ambulanten Arzneiverordnungen in der German Pharmacoepidemiological Research Database (GePaRD). 9. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi), 17.-20. September 2014, Ulm.
  • Jobski K, Schmedt N, Schink T, Garbe E. Co-morbidity and co-medication in elderly users of antidepressants in Germany. EuroDURG, 27-29 August 2014, Groningen, The Netherlands.
  • Jobski K, Schmedt N, Schink T, Garbe E. Drug use patterns and characteristics of elderly users of antidepressants in Germany. 59. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS), 7.-10. September 2014, Göttingen.
  • Schmedt N, Jobski K, Schink T, Garbe E. Neuroleptic and antidepressant use in the elderly German population. EuroDURG, 27-29 August 2014, Groningen, The Netherlands.
  • Schmedt N, Jobski K, Schink T, Garbe E. Drug use patterns and characteristics of elderly users of antidepressants in Germany. 30th International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 24-27 October 2014, Taipei, Taiwan.
  • Schmedt N, Jobski K, Schink T, Garbe E. Construction of treatment episodes in elderly neuroleptic and antidepressant users. 30th International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 24-27 October 2014, Taipei, Taiwan.