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Current Prescription Status of Contraindicated Drug Combinations Causing Serotonin Syndrome: Analysis of HIRA-NPS Data

Year: 2022

Type: article

Abstract: Serotonin syndrome is caused by excessive activation of serotonin receptors in the central nervous system. 1) This may occur when an overdose of a drug that increases serotonin levels is utilized or when two serotonergic drugs are used concurrently.2) Serotonergic drugs include monoamine oxidase inhibitors (MAOIs), selective serotonin receptor inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic anti-depressants, antipsychotics, opiate analgesics, etc. 1,[3][4][5][6][7][8][9][10][11][12][13] The symptoms of serotonin syndrome vary in severity.Mild cases may only experience tachycardia without fever and in some occasions autonomic findings such as diaphoresis, shivering, or mydriasis can be recognized on physical examination.2) Severe cases can be life-threatening, with high blood pressure and tachycardia, sustained clonus, muscle hypertonicity, and a ABSTRACT Background: Serotonin syndrome is a life-threatening disease if not appropriately treated.This study aimed to investigate the prescription status of contraindicated drug combinations that cause serotonin syndrome and identify the related factors.Methods: A cross-sectional study was conducted using nationwide claims data.Adult patients taking serotonergic drugs with Parkinson's disease or mental disorders were selected.Based on international medical databases (MDBs) and the Korean Drug Utilization Review (DUR), the status of prescribing contraindicated drug combinations that induce serotonin syndrome, the related factors, and the difference between international MDBs and the Korean DUR were analyzed.Results: Of the 49,773 study subjects, 163 (0.3%) were prescribed contraindicated serotonergic drug combinations based on international MDBs, and among them, only 105 (64.4%) were contraindicated by the Korean DUR.Positive influencing factors for prescribing contraindicated drug combinations include patient age between 65 and 74 and physician's specialties (neurologists, and orthopedists).Negative influencing factors were physician's specialty (internists) and medical institution (primary institutions).Conclusion: Despite the implementation of DUR, 3 out of 1,000 study subjects received contraindicated drug combinations that caused serotonin syndrome.Hence, it is necessary to comply with the DUR and improve it in accordance with international MDBs.

Source: Korean Journal of Clinical Pharmacy

DOI: 10.24304/kjcp.2022.32.4.313

Authors: Jae Gon Ryu, So Young Kim, Susin Park, Nam Kyung Je

Institutions: Samsung Changwon Hospital, Sungkyunkwan University, Kosin University Gospel Hospital, Woosuk University, Pusan National University

Language: English

Topic: Electroconvulsive Therapy Studies

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: Health Insurance Review and Assessment Service