Analiza povezanosti pogostosti predpisovanja in zastrupitev z zdravili z delovanjem na živčevje v Sloveniji

Karner, Gašper (author), Grabnar, Iztok (mentor), Dobravc Verbič, Matej (comentor)

Pogostost predpisovanja zdravil z delovanjem na živčevje se v zadnjih letih povečuje, zastrupitve z njimi pa v razvitih državah predstavljajo največji delež zastrupitev pri odraslih. Namen naše raziskave je bil analizirati povezanost pogostosti predpisovanja zdravil z delovanjem na živčevje in zastrupitvami z njimi v obdobju 2017-2021 v Republiki Sloveniji. Pri analizi predpisovanja smo spremljali trende števila predpisanih definiranih dnevnih odmerkov zdravil z delovanjem na živčevje. Pri analizi zastrupitev smo vključili vse bolnike, stare med 18 in 99 let, ki so bili med letoma 2017-2021 zaradi zastrupitve s psihotropnimi zdravili obravnavani v Ambulanti internistične prve pomoči Univerzitetnega kliničnega centra Ljubljana ali pa so bili v istem obdobju zaradi zastrupitve s psihotropnimi zdravili zabeleženi v Registru zastrupitev Republike Slovenije. Povezanost med predpisovanjem psihotropnih snovi in zastrupitvami z njimi smo na letni ravni med obdobjem 2017-2021 ugotavljali s Pearsonovim koeficientom korelacije, pri stopnji značilnosti 0,05. V petletnem obdobju je pogostost predpisovanja zdravil z delovanjem na živčevje narasla za 8,5 %. V Registru zastrupitev Republike Slovenije je bilo zaradi zastrupitev s psihotropnimi zdravili v enakem obdobju zabeleženih 2594 primerov, od tega 55,3 % pri ženskah. Mediana starosti bolnikov je bila 43 let. Največji delež bolnikov (33,5 %) je predstavljala starostna skupina 30-44 let. V Ambulanti internistične prve pomoči Univerzitetnega kliničnega centra Ljubljana so v tem času obravnavali 806 primerov zastrupitev s psihotropnimi zdravili. Največji delež predpisanih zdravil skupine N so v letih 2017-2021 predstavljali antidepresivi –41,5 % (escitalopram 10,3 %, sertralin 11,4 %), antipsihotiki – 8,6 % (olanzapin 2,2 %, kvetiapin 2,1 %) antiepileptiki – 8,2 % (pregabalin 2,5 %, valprojska kislina 1,1 %) in anksiolitiki – 8,0 % (alprazolam 2,9 %, lorazepam 1,8 %). Največ zastrupitev v istem obdobju je bilo z anksiolitiki – 41,0 % (alprazolam 14,5 %, diazepam 9,2 %), antipsihotiki – 36,1 % (kvetiapin 17,8 %, olanzapin 4,4 %) in antidepresivi – 25,8 % (sertralin 5,9 %, mirtazapin 3,9 %). Povezanost med predpisovanjem in zastrupitvami smo dokazali pri podskupinah antiepileptiki (R=0,9033, p=0,010), antipsihotiki (R=0,8822, p=0,048), hipnotiki in sedativi (R=0,9422, p=0,017) ter anksiolitiki (R=0,9204, p=0,027). Med posameznimi učinkovinami smo to povezanost dokazali pri zolpidemu (R=0,8907, p=0,043), risperidonu (R=0,8940, p=0,041) in alprazolamu (R=0,9063, p=0,034). Z izvedeno raziskavo smo prvič v Sloveniji izvedli analizo povezanosti predpisovanja in zastrupitev s psihotropnimi zdravili. V prihodnosti bi bilo smiselno podobno raziskavo izvesti za daljše časovno obdobje.

• Language: Slovenian
• Keywords: zdravila z delovanjem na živčevje, predpisovanje, zastrupitve, Register zastrupitev Republike Sloveniji, Internistična prva pomoč
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-143642
• Publication date in RUL: 05.01.2023

Secondary language

• Language: English
• Title: Analysis of association between the prescribing and poisoning rates for drugs acting on central nervous system in Slovenia

Abstract

The prescription of drugs acting on central nervous system has been increasing in recent years. They currently account for the largest proportion of poisonings in adults in developed countries. The aim of our study was to analyse the relation between the frequency of prescribing and poisonings for the drugs acting on the central nervous system during the period 2017-2021 in the Republic of Slovenia. For the prescribing analysis, we reviewed trends in the number of defined daily doses of drugs acting on central nervous system prescribed. For the analysis of poisonings, we included all patients aged between 18 and 99 years who were treated at the Outpatient Emergency Department of Internal Medicine at the University Medical Centre Ljubljana between 2017 and 2021 or were recorded in the Register of Poisonings of the Republic of Slovenia during the same period due to poisoning with psychotropic drugs. The association between the prescribing of psychotropic substances and poisonings was determined at an annual level during the period 2017-2021 using Pearson's correlation coefficient, at a significance level of 0.05. Over the five-year period, the prescribing rates for drugs acting on central nervous system increased by 8.5%. Register of Poisonings of the Republic of Slovenia recorded 2594 poisonings due to psychotropic drugs over a five-year period, 55.3% of which were women. The median age of the patients was 43 years. The largest proportion of patients (33.5%) was in the age group of 30-44 years. During this period, 806 cases of poisoning with psychotropic drugs were treated at the Outpatient Emergency Department of Internal Medicine at the University Medical Centre Ljubljana. Antidepressants accounted for the largest share of prescriptions for drugs acting on the central nervous system in 2017-2021, 41.5% (escitalopram 10.3%, sertraline 11.4%), antipsychotics – 8.6% (olanzapine 2.2%, quetiapine 2.1%) antiepileptics – 8.2% (pregabalin 2.5%, valproic acid 1.1%) and anxiolytics – 8.0% (alprazolam 2.9%, lorazepam 1.8%). Anxiolytics accounted for the largest share of poisonings with 41.0% (alprazolam 14.5%, diazepam 9.2%), antipsychotics – 36.1% (quetiapine 17.8%, olanzapine 4.4%) and antidepressants – 25.8% (sertraline 5.9%, mirtazapine 3.9%). The association between the prescribing and poisoning rates was demonstrated for the antiepileptics (R=0.9033, p=0.010), antipsychotics (R=0.8822, p=0.048), hypnotics and sedatives (R=0.9422, p=0.017) and anxiolytics subgroups (R=0,9204, p=0,027). Among the individual active substances, this association was demonstrated for zolpidem (R=0.8907, p=0.043), risperidone (R=0,8940, p=0,041) and alprazolam (R=0,9063, p=0,034).

• Keywords: drugs acting on central nervous system, prescribing, poisonings, Register of Poisonings of the Republic of Slovenia, Outpatient Emergency Department of Internal Medicine