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Titolo:
Who develops severe or fatal adverse drug reactions to selective serotoninreuptake inhibitors?
Autore:
Dalfen, AK; Stewart, DE;
Indirizzi:
Univ Toronto, Univ Hlth Network, Toronto, ON M5G 2N2, Canada Univ TorontoToronto ON Canada M5G 2N2 twork, Toronto, ON M5G 2N2, Canada
Titolo Testata:
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE
fascicolo: 3, volume: 46, anno: 2001,
pagine: 258 - 263
SICI:
0706-7437(200104)46:3<258:WDSOFA>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
TORSADE-DE-POINTES; TRICYCLIC ANTIDEPRESSANTS; FLUOXETINE; SERTRALINE; BRADYCARDIA; DEPRESSION; SYNCOPE; GENDER; ANGINA; RISK;
Keywords:
SSRIs; adverse drug reactions; drug interactions; cardiovascular disease; intentional overdose;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Clinical Medicine
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Stewart, DE Univ Toronto, Univ Hlth Network, 657 Univ Ave,ML-2-004, Toronto, ON M5G 2N2, Canada Univ Toronto 657 Univ Ave,ML-2-004 Toronto ON Canada M5G 2N2 a
Citazione:
A.K. Dalfen e D.E. Stewart, "Who develops severe or fatal adverse drug reactions to selective serotoninreuptake inhibitors?", CAN J PSY, 46(3), 2001, pp. 258-263

Abstract

Objective: To ascertain the risk factors associated with the development of severe and fatal adverse drug reactions (ADRs) or intentional overdoses by patients on selective serotonin reuptake inhibitors (SSRIs). Methods: We undertook a data analysis of Health Canada's database of Adverse Drug Reactions to SSRIs from 1986 to 1996 as well as a literature review. Results: Among the complete ADR reports in? the SSRI database there were no sex differences iii occurrences of all ADRs (n = 1011), severe ADRs (n = 295, drug-drug interactions (n = 312), deaths (n = 87), or intentional overdoses (n = 79), when sex differences in prescription practices were considered. There were no differences in ADR rates among different SSRIs. The most common cause of death among patients taking SSRIs was intentionaloverdose (n = 65, 74.7%). This was reported in 47 (72.3%) women and 18 (27.7%) men. The most common drugs taken with SSRIs in patients who died of intentional overdoses were benzodiazepines, tricyclic antidepressants (TCAs),narcotics, alcohol and diphenhydramine. Patients who had severe or fatal ADRs were more likely to be taking an SSRI with 2 or more other drugs, including alcohol Drug combinations that included another CYP-450 drug were especially problematic. A total of 129 cardiovascular ADRs were reported, most of which were severe, These included rhythm disturbances, blood pressure perturbations, and chest pain or angina. Cardiovascular ADRs mast often occurred with concomitant drug use of benzodiazepines, TCAs, histamine H-2 antagonists, lithium, and calcium channel blockers. There were 3 deaths from malignant neuroleptic syndrome unassociated with intentional overdose. Conclusions: SSRIs are relatively safe when their widespread use is compared with the prevalence of ADRs. SSRIs may, however he associated with ADRs,and even death, following intentional overdose or when taken with 2 or more other drugs or alcohol (particularly another drug metabolized by CYP-450). Physicians prescribing SSRIs need to consider drug-drug interactions and carefully monitor patients with severe affective disorders, comorbid medical conditions (especially cardiovascular disease), alcohol abuse, or a history of overdosing.

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Documento generato il 05/04/20 alle ore 12:06:25