1. CYP2D6-inhibiting drugs and risk of fall injuries after newly initiated antidepressant and antipsychotic therapy in a Swedish, register-based case-crossover study
- Author
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Max Vikström, Karin Leander, Karin Söderberg-Löfdal, Jette Möller, Clara Frumerie, Sofia Nordenmalm, and Marja-Liisa Dahl
- Subjects
Male ,Epidemiology ,medicine.medical_treatment ,0302 clinical medicine ,Drug Interactions ,Registries ,030212 general & internal medicine ,Aged, 80 and over ,chemistry.chemical_classification ,Sertraline ,Cross-Over Studies ,Multidisciplinary ,Middle Aged ,Antidepressive Agents ,Combination drug therapy ,Cytochrome P-450 CYP2D6 ,Medicine ,Antidepressant ,Female ,Antipsychotic Agents ,medicine.drug ,Adult ,medicine.medical_specialty ,CYP2D6 ,Science ,Risk of fall ,Trauma ,Article ,Young Adult ,03 medical and health sciences ,Cytochrome P-450 CYP2D6 Inhibitors ,Internal medicine ,medicine ,Humans ,Antipsychotic ,Aged ,Sweden ,Adverse effects ,business.industry ,Crossover study ,Risk factors ,chemistry ,Case-Control Studies ,Concomitant ,Accidental Falls ,business ,030217 neurology & neurosurgery ,Tricyclic - Abstract
Drug-drug interactions have been shown to affect the risk of fall injuries when opioids are used concomitantly with drugs inhibiting the cytochrome P450 2D6 (CYP2D6) enzyme in a previous pharmacoepidemiological study. The aim of this study was to determine whether CYP2D6-inhibiting drugs reinforce the risk of fall injuries when used concomitantly with antidepressants or antipsychotics. We identified all 252,704 adults with a first fall injury leading to hospitalisation from the National Patient Register in Sweden 2006–2013. Data on dispensed drugs was linked from the Swedish Prescribed Drug Register. We applied a case-crossover design to analyse newly dispensed (28 days preceding the fall injury, preceded by a 12-week washout period) antidepressants and antipsychotics, respectively, in relation to risk of a fall injury and according to concomitant use of CYP2D6-inhibiting drugs. Newly dispensed drugs were assessed correspondingly in a control period of equal length, 28 days prior to the 12-week washout period. Overall, the risk of fall injury was increased after newly initiated antidepressant and antipsychotic treatment. For antidepressants, concomitant CYP2D6 inhibitor use further elevated the risk estimates compared to non-use, most pronounced for the groups selective serotonin reuptake inhibitors (sertraline excluded) [OR = 1.47 (95% CI 1.19–1.80) vs. OR = 1.19 (95% CI 1.13–1.26)], and tricyclic antidepressants [OR = 1.71 (95% CI 1.17–2.51) vs. 1.27 (95% CI 1.11–1.47)] as well as for sertraline [OR = 1.61 (95% CI 1.05–2.38) vs. 1.12 (95% CI 1.00–1.26)]. For antipsychotics, the risk of fall injury was not altered by concomitant use of CYP2D6-inhibiting drugs. In conclusion, concomitant use of CYP2D6 inhibiting drugs tends to further increase the risk of fall injury in newly initiated antidepressant treatment, but not in antipsychotic treatment.
- Published
- 2021