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Nearly 90,000 ED visits annually linked to psychiatric drug events

By Sabriya Rice
Posted: September 3, 2014 - 4:00 pm ET

An estimated 267,000 patients visited an emergency department between 2009 and 2011 because of adverse drug events such as overdose, excessive sleepiness and head injuries associated with use of psychiatric prescriptions, a JAMA Psychiatry study finds. About 19% of the visits resulted in the patient being hospitalized.

The findings reinforce the need for more judicious prescribing of the drugs and for continued surveillance of outcomes associated with their use, researchers say.

“These drugs can be of benefit to people, but they should really be used with caution,” said lead study author, Dr. Lee Hampton of the Division of Healthcare Quality Promotion with the Centers for Disease Control and Prevention. “Whatever healthcare facilities can do to encourage alternative treatments is helpful,” he said.

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About 89,094 adult patients visited an emergency department annually because of adverse drug events from taking sedatives, antidepressants and antipsychotics, the study found.

About 30,707 annual ED visits were for patients taking sedatives or anxiety drugs; events such as altered mental state and excessive sleepiness were commonly reported.

An estimated 25,377 visits were related to use of antidepressants; patients often reported sensory issues, such as vertigo, and skin reactions, like hives.

Movement disorders and loss of muscle control were the most common adverse effects among the 21,578 estimated annual adverse event-related ED visits for antipsychotic medication use.

Though antipsychotics and antidepressants were the leading causes of the visits among adult patients between ages 19 and 44, sedatives and anxiety drugs were implicated in 38% of the visits for patients between ages 45 and 64, and 55% of the ED visits among patients 65 and older. The commonly used sedative, zolpidem tartrate, was implicated in 11.5% of all adult ED visits and in 21% of visits involving adults 65 years or older. The rate was significantly higher than any other psychiatric medication, the study said. Falls and head injuries were often cited among the adverse events.

“We didn't expect any one sedative to stand out that much,” Hampton said. The study did not investigate why the rates were higher; further studies are needed to investigate that aspect. Zolpidem tartrate is the active ingredient in Sanofi's Ambien and other generic forms of the sedative. The drug manufacturer declined to comment on the findings, saying the report looked at all forms of zolpidem, of which branded Ambien is one. “Most of the zolpidem market is generic, and we do not comment on a study of drugs we do not make,” responded a Sanofi spokesperson in an email.

Researchers from the CDC and the Johns Hopkins University schools of Medicine and of Public Health used data from the National Electronic Injury Surveillance System, Cooperative Adverse Drug Event Surveillance system, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to generate the findings.

Last September, the American Psychiatric Association released a list of recommendations for safe-prescribing of antipsychotics through the Choosing Wisely campaign. The APA recommended against prescribing antipsychotic medications to patients without continuously monitoring them, for example, and advised not to use the drugs as a first-line intervention for adults with insomnia.

Follow Sabriya Rice on Twitter: @MHSRice

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