ABSTRACT
UNLABELLED: Reducing drug related deaths has been identified as a health priority by the Scottish Executive. AIMS: This study investigates the association between drug related deaths in the Lothian region and prior contact with hospital-based services in the Edinburgh Royal Infirmary. DESIGN/SETTING: Retrospective analysis of 90 drug related deaths in Lothian from 2003-2005. Hospital episodes within five years of death were identified by searching the electronic patient record system within the Edinburgh Royal Infirmary. FINDINGS: Seventy-five of the 90 drug related deaths occurred in the hospital catchment area. Forty five of these 75 deaths (60%) occurred in patients who had used hospital-based services in the previous five years. The median time from hospital contact to deaths was five months and median number of hospital attendances/admissions was three (range 1 - 26). CONCLUSION: Liaison between emergency departments, clinical toxicology services and community based drug addiction services is important to identify drug misusers at high risk. A hospital-based specialist nurse-led liaison service may be able to fulfil this role.
Subject(s)
Hospitals/statistics & numerical data , Substance-Related Disorders/mortality , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Scotland/epidemiologyABSTRACT
The objective of this study was to investigate factors affecting steady-state plasma concentrations of thioridazine. A cross-sectional study of patients receiving chronic thioridazine was employed. Common allelic variants of CYP2D6 and CYP2C19, as well as thioridazine and metabolite concentrations and QTc intervals, were determined. In 97 patients, dose-corrected plasma concentrations (C/Ds) of thioridazine and metabolites were correlated with age but not sex or CYP2C19 genotype. Patients with no functional CYP2D6 alleles (n=9) had significantly higher C/D for thioridazine (P=0.017) and the ring sulfoxide metabolite and a significantly higher thioridazine/mesoridazine ratio compared with those with >/=1 functional CYP2D6 allele (n=82). Smokers had significantly lower C/D for thioridazine, mesoridazine, and sulforidazine and significantly lower thioridazine/ring sulfoxide ratios than non-smokers. QTc interval was not significantly affected by CYP2D6 or CYP2C19 genotypes. Plasma concentrations of thioridazine are influenced by age, smoking, and CYP2D6 genotype, but CYP2D6 genotype does not appear to influence on-treatment QTc interval.
Subject(s)
Antipsychotic Agents/adverse effects , Antipsychotic Agents/blood , Heart Conduction System/drug effects , Long QT Syndrome/chemically induced , Thioridazine/adverse effects , Thioridazine/blood , Adult , Age Factors , Aged , Aged, 80 and over , Alleles , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/pharmacokinetics , Aryl Hydrocarbon Hydroxylases/genetics , Aryl Hydrocarbon Hydroxylases/metabolism , Cross-Sectional Studies , Cytochrome P-450 CYP2C19 , Cytochrome P-450 CYP2D6/genetics , Cytochrome P-450 CYP2D6/metabolism , Dopamine Antagonists/adverse effects , Dopamine Antagonists/blood , Female , Genetic Variation , Genotype , Humans , Linear Models , Long QT Syndrome/blood , Long QT Syndrome/physiopathology , Male , Mesoridazine/adverse effects , Mesoridazine/blood , Middle Aged , Mixed Function Oxygenases/genetics , Mixed Function Oxygenases/metabolism , Risk Factors , Schizophrenia/drug therapy , Sex Factors , Smoking/adverse effects , Thioridazine/administration & dosage , Thioridazine/pharmacokinetics , White People/geneticsABSTRACT
We compared the effects of single doses of thioridazine and mesoridazine on the heart rate-corrected QT (QTc) interval in healthy adult volunteers. QTc intervals and plasma concentrations of thioridazine, mesoridazine, and metabolites were measured after single oral doses of thioridazine hydrochloride 50 mg, mesoridazine besylate 50 mg, or placebo in a double-blind, crossover study. Mean maximum increases in the QTc interval following thioridazine (37.3+/-4.1 ms, P=0.023) and mesoridazine (46.6+/-7.4 ms, P=0.021) were similar and significantly greater than following placebo (12.9+/-8.1 ms). The area under the effect-time curve over 8 h following drug administration was similar between the two drugs (129.3+/-22.1 vs 148.3+/-43.0 ms h). In conclusion, thioridazine and mesoridazine are associated with similar effects on the QTc interval.
