DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20161558

Pattern of adverse reactions of antipsychotics in a tertiary care hospital

Meenakshy T. Viswanathan, Asha Sisupalan, Vidhukumar Karunakaran

Abstract


Background: This study was undertaken to analyse the pattern of adverse drug reactions (ADR) of antipsychotics among patients attending the psychiatry outpatient department of a tertiary care centre.

Methods: Patients attending the psychiatry outpatient department who have been on treatment with one or more antipsychotics for more than 6 weeks were included in the study. Details about the prescription given in the previous appointment were collected. Various adverse effects associated with the use of antipsychotics were noted and analysed with special importance to obesity, elevated waist circumference and prolongation of QTc interval in ECG.

Results: The analysis of various adverse drug reactions in the study showed that the most common CNS side effects were drowsiness and tremor. The prevalence of severe EPS like parkinsonism, tardive dyskinesia and perioral tremors was very low. The prevalence of obesity and overweight was 47% and 14% respectively. The mean BMI of the study population was 24.44. Among the commonly prescribed antipsychotics, prevalence of obesity and overweight was highest in those patients on clozapine. The prevalence of QTc prolongation is 22% in this study.

Conclusions: The increasing use of atypical antipsychotics is associated with a different pattern of adverse drug reactions when compared to the typical drugs. Even though the prevalence of EPS is low, there is increased prevalence of metabolic side effects like obesity and diabetes mellitus.


Keywords


Antipsychotics, ADR, Obesity, QTc prolongation

Full Text:

PDF

References


Weinbrenner S, Assion H, Stargardt T, Busse R, Juckel G, Gericke CA. Drug prescription patterns in schizophrenia outpatients: analysis of data from a german health insurance fund. Pharmacopsychiatry. 2009;42(02):66-71.

Barnett D. Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia 43, national institute for clinical excellence, London, Technology Appraisal Guidance; 2002.

Sicras-Mainar A, Blanca-Tamayo M, Rejas-Gutiérrez J, Navarro-Artieda R. Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a cross-sectional assessment of a primary health care database. Eur Psychiatry. 2008;23(2):100-8.

Hsiao C, Ree S, Chiang Y, Yeh S, Chen C. Obesity in schizophrenic outpatients receiving antipsychotics in Taiwan. Psychiatry Clin Neurosci. 2004;58(4):403-9.

Simpson MM, Goetz RR, Devlin MJ, Goetz SA, Walsh BT. Weight gain and antipsychotic medication: differences between antipsychotic-free and treatment periods. J Clin Psychiatry. 2001;62(9):694-700.

Tarricone I, Casoria M, Gozzi BF, Grieco D, Menchetti M, Serretti A, et al. Metabolic risk factor profile associated with use of second generation antipsychotics: a cross sectional study in a community mental health centre. BMC Psychiatry. 2006;6:11.

Consensus Development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27(2):596-601.

Glassman AH, Bigger JT. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry. 2001;158(11):1774-82.

Part 3: training and practical guides section 3: guide to physical measurements (step 2) WHO STEPS Surveillance; 2011.

Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163-70.

Mirvis DM, Goldberger AL: Electrocardiography; in Libby (editors), braunwald's heart disease: a textbook of cardiovascular medicine, 8th ed. Saunders. 159-60.

Lehman AF, Lieberman JA, Dixon LB, McGlashan TH, Miller AL, Perkins DO, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161(2):1-56.

The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. J Clin Psychiatry. 2003;64(12):2-97.

Alessi-Severini S, Biscontri RG, Collins DM, Kozyrskyj A, Sareen J, Enns MW. Utilization and costs of antipsychotic agents: a Canadian population-based study, 1996-2006. Psychiatr Serv 2008;59(5):547-53.

Bret M, Bret P, Pariente A, Fourier-Réglat A. The use of atypical antipsychotics in French psychiatric hospitals. Pharmacy World and Science. 20071;29(5):551-6.

Tarsy D, Baldessarini RJ, Tarazi FI. Effects of newer antipsychotics on extrapyramidal function. CNS Drugs. 2002;16(1):23-45.

Bobes J, Rejas J, Garcia-Garcia M, Rico-Villademoros F, Garcia-Portilla MP, Madrigal M, et al. Frequency of extrapyramidal adverse reactions in schizophrenic outpatients treated with risperidone, olanzapine, quetiapine or haloperidol: the results of the EIRE study. Clin Drug Invest. 2002;22(9):609-22.

Davydov L, Botts S. Clozapine-induced hypersalivation. Ann Pharmacother. 2000;34(5):662-5.

Nayak V, Chogtu B, Devaramane V, Bhandary PV. Pedal edema with olanzepine. Indian J Pharmacol. 2009;41(1):49-50.

Bobes J, Portilla GA, Rejas MP, Ndez GM, Rico-Villademoros, et al Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: The results of the EIRE study. Journal of Sex and Marital Therapy. 2003;29:125-47.

Third national family health survey. Mumbai: international institute for population sciences; 2006.

Raman Kutty V, Joseph A, Soman CR. High prevalence of type 2 diabetes in an urban settlement in Kerala, India. Ethn Health. 1999;4(4):231-9.

Newcomer JW, Haupt DW, Fucetola R, Melson AK, Schweiger JA, Cooper BP, et al. Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia. Arch Gen Psychiatry. 2002;59(4):337-45.

Taylor DM, McAskill R. Atypical antipsychotics and weight gain a systematic review. Acta Psychiatr Scand. 2000;101(6):416-32.

Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry. 1999;156(11):1686-96.

Lamberti JS, Olson D, Crilly JF, Olivares T, Williams GC, Tu X, et al. Prevalence of the metabolic syndrome among patients receiving clozapine. Am J Psychiatry. 2006;163(7):1273-6.

Lund BC, Perry PJ, Brooks JM, Arndt S. Clozapine use in patients with schizophrenia and the risk of diabetes, hyperlipidemia, and hypertension: a claims-based approach. Arch Gen Psychiatry. 2001;58(12):1172-6.

Henderson DC, Cagliero E, Copeland PM, Borba CP, Evins E, Hayden D, et al. Glucose metabolism in patients with schizophrenia treated with atypical antipsychotic agents: a frequently sampled intravenous glucose tolerance test and minimal model analysis. Arch Gen Psychiatry. 2005;62(1):19-28.

Theisen FM, Linden A, Geller F, Schäfer H, Martin M, Remschmidt H, et al. Prevalence of obesity in adolescent and young adult patients with and without schizophrenia and in relationship to antipsychotic medication. J Psychiatr Res. 2001;35(6):339-45.

R Welch, P Chue. Antipsychotic agents and QT changes. J Psychiatry Neurosci. 2000;25(2):154-60.