Implementation of warnings from Dear Doctor Letters (Rote-Hand-Briefe): an analysis of medication data from a large cohort of elderly patients.

摘要: When studying the incidence of medication errors, we repeatedly noticed occurrence non-adherence to contraindications that were also subject recent Dear Doctor Letters (known as Rote-Hand-Briefe in Germany or Direct Healthcare Professional Communications [DHPCs] other countries) (1). The question therefore naturally arose: how far, and fast, are safety-related contents these letters actually implemented everyday clinical practice? In Germany, around 20 40 issued every year. purpose is inform relevant healthcare professionals (physicians pharmacists) about significant newly discovered drug risks measures reduce them even before official prescribing information (also known Summary Product Characteristics, SmPC) updated (2). In October 2011, a Letter was released on dose-dependent QT interval prolongation caused by citalopram. Important points reduction maximum daily dose mg patients aged >65 years those with impaired liver function, new contraindication for administration citalopram existing prolonged combination interval–prolonging drugs (3– 5) (eBox). eBox Main relating (dated 31 2011) escitalopram 5 December 2011) Citalopram have been associated QT-interval prolongation. The recommended limited citalopram; it remains at mg. For older (>65 years) maxima reduced 10 mg, respectively, absence risk factors. Use either substances any prolong from this date regarded contraindicated. Examples are: Class IA III antiarrhythmics Tricyclic antidepressants Antipsychotics (e.g., phenthiazine derivatives, pimocide, haloperidol) Certain antibiotics moxifloxacin, sparfloxacin, erythromycin IV, pentamidine, antimalarials, especially halofantrin) Certain antihistamines astemizole, mizolastine) Administration both contraindicated interval–prolongation congenital long-QT syndrome. In addition hypokalemia pre-existing interval–prolongation, female sex named factor. In increased torsade-de-pointes tachycardia, e.g., heart failure, myocardial infarction, bradyarrhythmia, tendency hypomagnesemia related accompanying diseases medications, caution indicated. Two months later, similar warning (6– 8); again, citalopram, limited, These instructions use included originator products early 2011 Cipralex® March 2012 Cipramil®, generics (available only citalopram) May 2012. Both genetic drug-induced disturbances muscle cell repolarization can show up ECG interval. Since length depends rate, given usually corrected rate (QTc). A patient QTc Torsade de pointes (TdP) which lead ventricular fibrillation (9, 10). We took an example investigate implementation recommendations made patients, using data Geriatrics Bavaria–Database (Geriatrie Bayern Datenbank, GiB-DAT). warnings must be assumed particular relevance elderly because multimorbidity polypharmacy group.