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Drug‐related problems of antipsychotics in treating delirium among elderly patients: A real‐world observational study.
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- Author(s): Jenraumjit, Rewadee1 ; Somboon, Jinjuta2; Chainan, Sirapim3; Chuenchom, Pao4; Wongpakaran, Nahathai5; Wongpakaran, Tinakon5
- Source:
Journal of Clinical Pharmacy & Therapeutics. Oct2021, Vol. 46 Issue 5, p1274-1280. 7p.- Subject Terms:
*DRUG side effects; *DRUG administration routes; *SCIENTIFIC observation; *INTRAVENOUS therapy; *ORAL drug administration; *QUETIAPINE; *RETROSPECTIVE studies; *RISK assessment; *HALOPERIDOL; *INAPPROPRIATE prescribing (Medicine); *DELIRIUM; *DRUG interactions; *DESCRIPTIVE statistics; *ANTIPSYCHOTIC agents; *ELDER care; *RISPERIDONE; *OLD age - Source:
- Additional Information
- Subject Terms:
- Abstract: What is known and Objective: Delirium is more common and life‐threatening among the elderly. Currently, no other medications, including antipsychotics, have been approved for delirium. The number of practice guidelines recommends antipsychotics to be the first option among selected patients. This study aimed to identify the type of drug‐related problems (DRPs) concerning antipsychotics use among elderly patients with delirium. Methods: A retrospective observational study was conducted by collecting data from 2013 to 2016 in Maharaj Nakorn Chiang Mai Hospital, Thailand. Inpatients who were 60 years and over, diagnosed with delirium by ICD‐10 diseases coding F05.X and treated with antipsychotics for delirium were included. A modified version of the American Society of Hospital Pharmacists classification criteria (mASHP‐delirium) was used. Results and discussion: A total of 379 patients were enrolled. Mean daily dose of haloperidol (oral) was 1.06 ± 1.33 mg, haloperidol (intramuscular) 2.71 ± 1.88 mg, haloperidol (intravenous; IV) 3.42 ± 1.97 mg, risperidone was 0.71 ± 0.52 mg, and quetiapine was 19.26 ± 15.63 mg. Among all, 427 events were classified as DRPs. The most common DRPs included inappropriate duration, dose, route of administration or dosage form accounting for the 416 events (97.4%), followed by actual adverse drug reactions (extrapyramidal symptoms; EPS), 6 events (1.4%) and potential drug‐drug interactions for 5 events (1.2%). Of those 416 events, 200 events (48.1%) antipsychotics were continued after discharge and continued for more than 10 days. Dosage exceeding initial dose or maximum daily dose accounted for 179 events (43.0%). Other DRPs such as inappropriate route haloperidol IV and receiving the extended‐release dosage form of quetiapine involve 26 (6.3%) and 11 (2.6%) events, respectively. What is new and Conclusion: To the best of our knowledge, this is the first study using mASHP‐delirium to identify DRPs of antipsychotics in treating delirium among elderly patients. Several DRPs were found that might lead to severe adverse drug reactions, particularly EPS and QTc interval prolongation. However, all DRPs could be prevented by developing antipsychotic setting protocols and specialty consulting systems to communicate among healthcare providers caring for vulnerable groups of patients. In addition, a prospective pharmacist intervention is required. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of Clinical Pharmacy & Therapeutics is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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