Estudio de mortalidad de pacientes en tratamiento con digoxina y trazodona / Study of mortality on patients with digoxin and trazodone treatment

Objetivos: Analizar la influencia de trazodona en la mortalidad de pacientes en tratamiento con digoxina. Material y métodos: Estudio observacional retrospectivo comparativo de mortalidad de pacientes en tratamiento concomitante con digoxina y trazodona versus digoxina. El período de estudio fue de un año (1 de mayo de 2020 hasta 30 de abril de 2021). Las variables recogidas fueron edad, sexo, indicación, dosis de digoxina y trazodona, fecha de inicio de trazodona, fecha fin de digoxina y trazodona, número total de fármacos prescritos, éxitus y fecha de éxitus. El análisis estadístico se realizó mediante la aplicación Stata®. Versión 14.2. Resultados: Se incluyeron 644 pacientes en tratamiento con digoxina, 73 en el grupo con trazodona y 571 en el grupo sin trazodona. Al final del periodo estudiado se registraron 73 muertes, observándose una mortalidad del 34,3% en el grupo de digoxina y trazodona, y del 8,4% en el grupo de digoxina. Las variables relacionadas con el riesgo de muerte fueron tratamiento con tradozona, edad y número de tratamientos prescritos. Conclusiones: Los resultados del estudio sugieren un incremento del riesgo de mortalidad en pacientes de edad avanzada en tratamiento con digoxina y trazodona. La falta de evidencia de uso de trazodona como hipnótico, la interacción farmacocinética entre ambos fármacos y el perfil de seguridad de trazodona, hace necesario una estrecha monitorización de los pacientes o valorar alternativas con mayores evidencias de seguridad.(AU)

Objectives: To evaluate the trazodone influence on the mortality of patients treated with digoxin. Material and methods: Retrospective, observational, comparative study that included patients receiving trazodone and digoxin concomitantly and patients on digoxin treatment without trazodone between April 2020-April 2021. Age, sex, drug indication, digoxin and trazodone dosage, start and end dates of trazodone use, digoxin end date, number of prescribed drugs and death date were the variables we paid attention to. Statistical analysis was performed using the Stata® application. Version 14.2. Results: 644 patients were included, 73 in the group digoxin with trazodone and 571 in the group without trazodone. At the end of the study period, 73 deaths were recorded. Mortality in the digoxin and trazodone group were 34.3% and 8.4% in the digoxin group. The variables related to the risk of death were treatment with trazodone, age and number of prescribed treatments. Conclusions: The results of the study suggest an increased risk of mortality in elderly patients in treated with digoxin and trazodone. The lack of evidence in the use of trazodone as a hypnotic, the pharmacokinetic interaction between both drugs and the safety profile of trazodone, makes it necessary to closely monitor patients or assess therapeutic alternatives with more evidence to be sure its use is safe.(AU)

Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report.

WHAT IS KNOWN AND OBJECTIVE: Levetiracetam is used in the treatment of some forms of epilepsy. In renal impairment and patients on chronic haemodialysis, dose adjustment is required. We report a case. CASE DESCRIPTION: This case report describes a woman on levetiracetam treatment who presented with generalized tonic-clonic seizures during a haemodialysis session. We report on treatment adjustment and on the impact of dialysis on levetiracetam levels. WHAT IS NEW AND CONCLUSION: Haemodialysis reduces serum levetiracetam concentration and can lead to subtherapeutic levels. Close monitoring is necessary when dialysis is used on patients receiving anticonvulsant drugs that are extensively eliminated by the procedure.