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1.
Bipolar Disord ; 21(5): 419-427, 2019 08.
Article in English | MEDLINE | ID: mdl-30472760

ABSTRACT

OBJECTIVES: Laboratory monitoring of patients using lithium is important to prevent harm and to increase effectiveness. The aim of this study is to determine compliance with the guidelines for laboratory monitoring of patients treated with lithium overall and within subgroups. METHODS: Patients having at least one lithium dispensing for 6 months or longer between January 2010 and December 2015 were identified retrospectively using data from the Dutch PHARMO Database Network. Laboratory monitoring was defined as being compliant with the Dutch Multidisciplinary Clinical Guideline Bipolar Disorders when lithium serum levels, creatinine and thyroid-stimulating hormone (TSH) had been measured at least every 6 months during lithium use. RESULTS: Data were analyzed from 1583 patients with a median duration of 7- to 6-months period of lithium use. Results indicated that patients had been monitored over 6-month period for lithium serum levels 65% of the time, for creatinine 73% of the time and for TSH 54% of the time. Just over one seventh (16%) of patients had been monitored in compliance with the guidelines for all three parameters during total follow-up. Especially males, patients aged below 65 years, patients receiving prescriptions solely from general practitioners, prevalent users of lithium, patients without interacting co-medication, and patients without other days with laboratory measurements had been monitored less frequently in compliance with the guidelines. CONCLUSIONS: A considerable proportion of patients had not been monitored in accordance with the guidelines. Further research is needed to understand the reasons for noncompliance and to implement strategies with the ultimate goal of optimizing safety and effectiveness for patients treated with lithium.


Subject(s)
Bipolar Disorder/drug therapy , Lithium Compounds/therapeutic use , Adolescent , Adult , Aged , Bipolar Disorder/blood , Creatinine/blood , Databases, Factual , Female , Follow-Up Studies , Humans , Lithium Compounds/blood , Male , Middle Aged , Netherlands , Practice Guidelines as Topic , Retrospective Studies , Thyrotropin/blood , Young Adult
3.
BMJ Case Rep ; 20172017 May 27.
Article in English | MEDLINE | ID: mdl-28551597

ABSTRACT

A 63-year-old woman with diabetes type II and a history of breast cancer was treated with clozapine for her refractory schizophrenia. She developed a dilated cardiomyopathy with an ejection fraction of 25%, a life-threatening event. The cause of heart failure could be multifactorial, with clozapine, family history, chemotherapy, diabetes type II and/or lithium as possible contributing risk factors. Clozapine was discontinued and the patient was referred to a hospice. Two weeks later, her heart failure slowly improved. Subsequently, she became extremely psychotic with a severe decline in quality of life. Therefore, it was decided to restart clozapine under cardiac monitoring. The patient's psychotic symptoms improved and her heart failure status remained stable for more than a year. Thereafter, a small deterioration was seen in cardiac function. In this case, re-exposure to clozapine was successful for at least 2 years.


Subject(s)
Antipsychotic Agents/adverse effects , Cardiomyopathy, Dilated/chemically induced , Clozapine/adverse effects , Heart Failure/chemically induced , Schizophrenia/drug therapy , Antipsychotic Agents/administration & dosage , Clozapine/administration & dosage , Diabetes Mellitus, Type 2 , Drug Administration Schedule , Female , Humans , Middle Aged , Quality of Life , Recurrence , Schizophrenia/physiopathology , Treatment Outcome
5.
J Psychopharmacol ; 29(12): 1248-54, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26464457

ABSTRACT

The Summary of Product Characteristics (SmPC) for psychotropic drugs includes instructions for clinical and biomarker monitoring intended to optimise effectiveness and minimise harm. The present study evaluated which monitoring instructions are given in the SmPCs, and assessed whether instructions are informative enough to be applicable in clinical practice. Monitoring instructions were collected from complete SmPCs for psychotropic drugs (n=70). Reasons and requirements for monitoring were assessed and somatic parameters were distinguished from non-somatic parameters. Instructions were evaluated using the Systematic Information for Monitoring (SIM) score and considered applicable when a SIM score of ⩾ 3 was found. An average of 3.3 (range 0-13) instructions per drug label was found. Monitoring was primarily for safety reasons (78%). Requirement was predominantly mandatory (71%). Somatic parameters were most often mentioned (80%). Only 34% of the instructions were determined applicable. Overall, an average SIM score of 2.0 (SD=1.7) was found (out of a maximum possible score of 6). In conclusion, prescribing of psychotropic drugs is accompanied by diverse instructions aimed at improving safe use. However, most instructions on monitoring do not provide sufficient information to be applicable in clinical practice.


Subject(s)
Biomarkers/metabolism , Psychotropic Drugs/therapeutic use , Drug Labeling/methods , Drug Prescriptions , Humans
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