Studies of Utilization of Mood Stabilizers and Related Adverse Drug Reactions in Bipolar Patients
Date Issued
2006
Date
2006
Author(s)
Chau, Pei-Fang
DOI
zh-TW
Abstract
Background The mood stabilizers for bipolar disorder include lithium, valproate and carbamazepine. According to previous studies, lithium and carbamazepine were considered to be associated with the development of hypothyroidism and SJS/TEN, respectively. The pharmacoepidemiology data for bipolar patients is important for clinical practice and medical policy.
Objective To analyze the prescription pattern of bipolar disorders from 1997 to 2004. To evaluate the adverse drug reactions, i.e. hypothyroidism and SJS/TEN, of mood stabilizers in bipolar patients.
Methods The Psychiatric Inpatient Medical Claim dataset (PIMC) in Taiwan was used in this study. Medical claim data between 1997 to 2004 of the bipolar patients diagnosed during 1996-2001 were retrieved. The utilization patterns of mood stabilizers, antipsychotics, antidepressants and electroconvulsive therapy were calculated and analyzed. The matched case-control design with one case to four controls was used for the ADR studies. Bipolar patients who fit the inclusion criteria of case group were screened first. The control group of the same age range and sex to the cases was retrieved from patients other than the case group. Conditional logistic regression model using to calculate the adjusted odds ratio was applied to analyze the relationship between hypothyrodism or severe skin reactions and the drugs used by the bipolar patients.
Results A total of 12,424 patients of bipolar disorder who had a mean age of 40.2 year old and equal gender ratio were included. From 1997-2004, the use of atypical antipsychotics (β=0.42, p<0.0001) increased significantly with a decrease in typical antipsychotics (β= - 0.23, p<0.0001). For mood stabilizers, the prescriptions of valproate (β=0.25, p<0.0001) increased significantly along with the significant decreases of lithium (β=-0.091, p<0.0001) and carbamazepine (β=-0.096, p<0.0001). A total of 557 bipolar patients with hypothyroidism were identified and 2,228 controls were selected. The mean age of these patients was 41.3 year old with a ratio of man to women 1:3. After adjustment, lithium did not exhibit higher risk in hypothyroidism as compared to carbamazepine and valproate. Patients who have ever used both lithium and valproate or who have ever used all the three mood stabilizers have significant risk of developing hypothyroidism. If considered the number of mood stabilizers used as a continuous factor, it was found that the more mood stabilizers used the higher risk in developing hypothyroidism (OR 1.34, 95% CI 1.21-1.49). There were 74 cases with severe skin reactions and two of them did not have any prescription within the 60 days before the index date. Finally, 72 cases and 288 controls were identified from the 12,424 bipolar patients. The number of man and women were about the same with a mean age of 41.3 years old. After multivariate analysis, carbamazepine and valproate were found significantly associated with severe skin reactions. The other anticonvulsants also had significant association as calculated as a group of drugs. Among the suspicious drugs, carbamazepine showed the highest risk in developing the severe skin reactions (OR 4.02, 95% CI 1.97-8.27).
Conclusions The prescription pattern of bipolar disorder during 1997 to 2004 has a significant change and this change seems to be consistent with recent guidelines. Using more than two mood stabilizers may lead to a higher risk of hypothyroidism. Closely monitor thyroid function for these patients may be necessary. Carbamazepine has the highest risk of causing severe skin reactions among all suspicious drugs in bipolar patients. The association of other anticonvulsants also could not be ignored. It is important to be aware of shin reactions during anticonvulsants treatment.
Subjects
躁鬱症
情緒穩定劑
副作用
bipolar
mood stabilizer
hypothyroidism
SJS
Type
text
File(s)![Thumbnail Image]()
Loading...
Name
ntu-95-R93451007-1.pdf
Size
23.31 KB
Format
Adobe PDF
Checksum
(MD5):21a29e077a98741bbfbe74a0af24410b