Antidepressant prescribing patterns and adverse events following introduction of a National Prescribing Indicator to monitor dosulepin usage in Wales

Katherine Chaplin, Robert Bracchi, Kathryn Haines, Philip Alexander Routledge, Paul Nicholas Deslandes*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Aim
Limiting use of the antidepressant dosulepin has been encouraged due to associated risks of toxicity. In April 2011 the All Wales Medicines Strategy Group introduced a National Prescribing Indicator (NPI) to monitor dosulepin usage. The aim of this study was to investigate antidepressant prescribing patterns, and selected adverse events in patients prescribed dosulepin following introduction of the NPI.

Methods
An e-cohort study was conducted. Adult patients receiving regular dosulepin prescriptions between October 2010 and March 2011 were included. Characteristics of patients who were continued on dosulepin, were switched to an alternative antidepressant, or whose dosulepin was discontinued following introduction of the NPI were compared.

Results
4,121 patients were included. Of these, 1,947 (47%) continued dosulepin, 1,487 (36%) were switched, and 692 (17%) discontinued. Of the 692 who discontinued, 92% did not receive a prescription for another antidepressant during the follow-up period. Patients whose dosulepin was discontinued were older, and were less commonly co-prescribed benzodiazepines. During follow-up, recorded incidence of selected adverse events was low across all groups and no significant difference was observed.

Conclusions
Over half of patients had discontinued dosulepin at the end of the period when the NPI was in place. Further interventions may have been required to have a greater impact on prescribing. This study provides some reassurance that dosulepin discontinuation can be a successful strategy, and that the risk of the adverse events investigated was unlikely to have been greater in those who had dosulepin discontinued than in those in whom dosulepin had been continued.
Original languageEnglish
Article number15840
Pages (from-to)3596-3605
Number of pages10
JournalBritish Journal of Clinical Pharmacology
Volume89
Issue number12
Early online date4 Jul 2023
DOIs
Publication statusPublished - 1 Dec 2023

Keywords

  • Dosulepin
  • antidepressant
  • prescribing
  • adverse effect

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