Association between the use of serotonin receptor 2A-blocking antidepressants and joint disorders.

OBJECTIVE: There are case reports about antidepressants causing arthritis and arthralgia, and the majority of these reports deal with atypical antidepressants, which are serotonin receptor 2A (5-HT(2A))-blocking substances. The aim of this study was to examine a possible association between joint disorders and the use of 5-HT(2A)-blocking atypical antidepressants. METHODS: We performed a retrospective study using reports of adverse drug reactions (ADRs) of 5-HT(2A)-blocking atypical antidepressant substances concerning joint disorders reported to the Swedish Adverse Drug Reactions Committee and the World Health Organization (WHO) Adverse Reactions Database during the period January 1, 1990 to December 31, 2006. The reports of joint disorders were related to sales figures measured as defined daily doses and to the total number of ADR reports. RESULTS: In the Swedish material, the 5-HT(2A) antagonists were 45 times more often reported to give joint ADRs when related to sales figures and compared with the selective serotonin reuptake inhibitors (SSRIs; P < 0.001). Joint disorders constituted 6.6% of the total number of reports of possible ADRs for the three 5-HT(2A)-blocking substances mianserin, mirtazapine, and nefazodone compared with 0.5% for the SSRIs (P < 0.001). In the WHO material, the joint disorders constituted 1.3% of all ADRs for the 5-HT(2A)-blocking antidepressants and 0.6% for the SSRIs (P < 0.001). CONCLUSION: In this study, joint disorders were considerably more frequently reported ADRs of 5-HT(2A)-blocking antidepressants than of other comparable drugs, suggesting a possible association between the use of 5-HT(2A)-blocking antidepressants and joint disorders.

[GPs' perceptions of the Institute for Rational Pharmacotherapy]. / Praktiserende laegers opfattelse af Institut for Rationel Farmakoterapi.

INTRODUCTION: A questionnaire study was conducted among Danish general practitioners (GPs) as part of an international evaluation of the Institute for Rational Pharmacotherapy (IRF). The aim was to investigate GPs' use and opinion of the IRF's activities. MATERIAL AND METHODS: A questionnaire was sent to a random sample of 500 GPs, who were asked about their level of knowledge and frequency of use of IRF's activities, as well as their opinion on the relevance, credibility and independence of the IRF's activities. RESULTS: The response rate was 59%. IRF is generally not the first source of information about new drugs, but is frequently used in the search for information about comparability between drugs and in relation to sudden drug warnings. IRF's Rational Pharmacotherapy bulletin and its GP courses, which nine out of ten GPs knew about, were considered to be highly relevant by 80% and 71%, respectively. All of IRF's activities were considered highly credible. Most GPs felt that the IRF's information increased their confidence in prescribing decisions (84%) and supported them in their role as a GP (88%). CONCLUSION: IRF's activities support the GP's prescribing role through the production of credible, neutral and evidence-based pharmacotherapeutic information that is not available elsewhere. IRF could further refine its dissemination methods, however, in order to reach more GPs and to increase the use of its information.

[Treatment with tramadol can give rise to dependence and abuse]. / Tramadolanvändning kan skapa beroende och missbruk.

Tramadol is a centrally acting opioid analgesic which is increasingly used in Sweden. Dependence, abuse and withdrawal has been reported in patients treated with tramadol. The incidence of these adverse effects is considered to be low. Patients with a history of substance abuse might be at higher risk than others to develop dependence. The number of forged tramadol prescriptions uncovered in Swedish pharmacies was relatively low in 2001, compared to those of prophoxyphene and codeine, but increasing.

Adverse drug reactions as a cause for admissions to a department of internal medicine.

PURPOSE: To assess the occurrence and pattern of adverse drug reactions as a cause for acute hospital admission. METHODS: In 681 randomly selected patients, acutely admitted to a clinic of internal medicine at a Swedish university hospital, information was collected from their medical records about current symptoms and use of drugs, previous diseases and the results of medical investigations and tests. In addition, a standardized interview according to a questionnaire was carried out. A group of experts in clinical pharmacology assessed the data obtained from the patients' case records and the results of the interviews, and then, according to WHO criteria, judged the probability that an adverse drug reaction could have caused or contributed to the actual admission to hospital. RESULTS: Out of the 681 cases included, 94 (13.8%) had symptoms and signs that were judged as drug-related and that had caused or contributed to the admission. Eighty-two patients (12.0%) had altogether 99 symptoms that were classified as adverse drug reactions. Of these, 91% were type A reactions. The relationship between the medication and the reaction was judged certain in eight, probable in 17, and possible in 74 cases. The most common adverse drug reactions were cardiovascular (36.3%). Twelve patients (1.8%) had symptoms indicating intoxications. CONCLUSIONS: The prevalence of drug-related problems causing or contributing to admission to a clinic of internal medicine is high and is dominated by type A reactions, i.e. reactions in principle predictable and preventable. This implies a possibility to increase drug safety by preventive measures.