Silvia Ravera

Road traffic accidents and psychotropic medication use in the Netherlands: a case-control study

AIM To examine the association between the use of commonly prescribed psychotropic medications and road traffic accident risk. METHODS A record-linkage database was used to perform a case-control study in The Netherlands. The data came from three sources: pharmacy prescription data, police traffic accident data and driving licence data. Cases were defined as drivers, who had a traffic accident that required medical assistance between 2000 and 2007. Controls were defined as adults, who had a driving licence and had no traffic accident during the study period. Four controls were matched for each case. The following psychotropic medicine groups were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants stratified in the two groups, SSRIs and other antidepressants. Various variables, such as age, gender, medicine half-life and alcohol use, were considered for the analysis. RESULTS Three thousand nine hundred and sixty-three cases and 18,828 controls were included in the case-control analysis. A significant association was found between traffic accident risk and exposure to anxiolytics (OR = 1.54, 95% CI 1.11, 2.15), and SSRIs (OR = 2.03, 95% CI 1.31, 3.14). A statistically significant increased risk was also seen in chronic anxiolytic users, females and young users (18 to 29 years old), chronic SSRI users, females and middle-aged users (30 to 59 years old), and intermediate half-life hypnotic users. CONCLUSIONS The results of this study support previous findings and confirm that psychoactive medications can constitute a problem in traffic safety. Both health care providers and patients should be properly informed of the potential risks associated with the use of these medicines.

A European approach to categorizing medicines for fitness to drive: outcomes of the DRUID project

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

The use of driving impairing medicines: a European survey

AimTo analyse the consumption of a number of medicines with a known potential for increasing the risk of road traffic accidents in the general population of Europe.MethodsQuestionnaires were distributed through the European Drug Utilization Research Group (EuroDURG) and Post-Innovation Learning through Life-events of drugs (PILLS) networks. A total of 30 countries (the current EU Member States, Iceland, Norway and Switzerland) were asked to supply data on the use of driving impairing medicines for the period 2000–2005, aggregated at the level of the active substance and presented in Defined Daily Doses (DDDs) per 1000 inhabitants per day.ResultsNational utilization data were provided by 12 of the 30 countries. Based on these data, a considerable increase in consumption was only seen for the antidepressants and the selective serotonin reuptake inhibitors. A slight increase, decrease or no increase was seen for the rest of the drugs studied (i.e. opioids, antipsychotics, anxiolytics, hypnotics and sedatives, drugs that are used in addictive disorders and antihistamines). Limitations were encountered when data on driving impairing medicines were compared between countries (e.g. variation in the data sources and providers, population coverage, inclusion of hospital data, use of divergent ATC/DDD versions) and, therefore, a cross-national comparison could not be performed.ConclusionsDuring the study period, trends within countries showed slight to no increase in the consumption of selected medicinal drug groups, with the exception of the antidepressants and the selective serotonin reuptake inhibitors: they showed a remarkable increased use during the study time-frame. Our results illustrate that it is still difficult to perform a valid and comprehensive collection of drug utilization data on driving impairing medicines. Therefore, efforts to harmonize data collection techniques are required and recommended.

Prevalence, Cumulative Incidence, Monotherapy and Combination Therapy, and Treatment Duration of Frequently Prescribed Psychoactive Medications in the Netherlands: Retrospective Database Analysis for the Years 2000 to 2005

BACKGROUND Psychoactive drugs have been reported to impair daily activities (eg, driving), but data regarding the use of such drugs in the Netherlands are lacking. OBJECTIVE The aim of this work was to examine the prevalence, cumulative incidence, use of monotherapy and combination therapy, and treatment duration of frequently prescribed psychoactive drug classes in the Netherlands. METHODS Data for the years 2000 through 2005 were derived from IADB.nl, a database with pharmacy dispensing data from a population of ∼500,000 people in the northern region of the Netherlands. The following prescription psychotropic drug classes were considered: antidepressants (as a total group and the 2 subgroups of nonselective monoamine reuptake inhibitors and selective serotonin reuptake inhibitors), antipsychotics, anxiolytics, and hypnotics and sedatives. Patients aged 18 to 89 years who received ≥ 1 prescription for a psychoactive medication of interest were selected, and prevalence and cumulative incidence were calculated per 1000 patients per year. The treatment duration was analyzed by means of Kaplan-Meier survival analysis. Age, sex, and drug class stratifications were performed. RESULTS There was a slight increase in the prevalence of antipsychotics (final median [95% CI] prevalence in 2000 vs 2005: 16.9 [16.5-17.3] vs 18.7 [18.3-19.1]) and antidepressants (60.4 [59.7-61.2] vs 67.1 [66.4-67.9]), with selective serotonin reuptake inhibitors being the most frequently prescribed drugs in these classes (35.2 [34.6-35.7] vs 37.5 [36.9-38.1] in 2000 and 2005, respectively). At the same time, there was a slight decrease in the prevalence of anxiolytics (95.1 [94.2-96.0] vs 83.2 [82.3-84.0]), hypnotics and sedatives (68.1 [67.3-68.9] vs 60.9 [60.1-61.6]), and nonselective monoamine reuptake inhibitors (20.3 [19.8-20.7] vs 19.2 [18.8-19.7]). The data also suggested that women had more prescriptions for the psychoactive medications of interest than did men, although these observations were not assessed for statistical significance. The only increase from 2000 to 2005 in median (95% CI) incidence per 1000 people in prescriptions was for antipsychotics (4.1 [3.9-4.3] vs 4.9 [4.6-5.0]); a decrease was noted in the incidence of antidepressants (18.6 [18.2-19.1] vs 16.2 [15.8-16.6]), nonselective monoamine reuptake inhibitors (7.1 [6.9-7.4] vs 6.8 [6.6-7.1]), selective serotonin reuptake inhibitors (12.0 [11.6-12.3] vs 8.6 [8.3-8.9]), anxiolytics (34.6 [34.1-35.2] vs 30.2 [29.7-30.7]), and hypnotics and sedatives (21.2 [20.8-21.7] vs 18.4 [18.0-18.9]). Combination therapy was most common among those aged 30 to 44 years (6.5%) and those aged 45 to 59 years (6.1%). The longest median (95% CI) treatment duration was noted for antipsychotic use (1781.8 days [1755.2-1808.4]); the shortest was observed for anxiolytic use (617.4 days [608.9-625.9]). CONCLUSIONS From 2000 to 2005 in the Netherlands, the yearly prevalence and cumulative incidence of prescriptions for psychoactive drugs were relatively stable, although there were some changes within specific drug classes. Monotherapy was more prevalent than combination therapy. Antipsychotics had the longest median duration of use; anxiolytics had the shortest duration.

Are Selective Serotonin Reuptake Inhibitors Safe for Drivers? What is the Evidence?

BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are widely used medications to treat several psychiatric diseases and, above all, depression. They seem to be as effective as older antidepressants but have a different adverse effect profile. Despite their favorable safety profile, little is known about their influence on traffic safety. OBJECTIVE To conduct a literature review to summarize the current evidence on the role of SSRIs in traffic safety, particularly concerning undesirable effects that could potentially impair fitness to drive, experimental and pharmacoepidemiologic studies on driving impairment, 2 existing categorization systems for driving-impairing medications, and the European legislative procedures for assessing fitness to drive before issuing a drivers license and driving under the influence of medicines. METHODS The article search was performed in the following electronic databases: MEDLINE, PsycINFO, ScienceDirect, and SafetyLit. The English-language scientific literature was searched using key words such as SSRIs and psychomotor performance, car crash or traffic accident, and adverse effects. For inclusion in this review, papers had to be full-text articles, refer to possible driving-related adverse effects, and be experimental or pharmacoepidemiologic studies on SSRIs and traffic accident risks. No restrictions concerning publication year were applied. RESULTS Ten articles were selected as background information on driving-related adverse effects, and 15 articles were selected regarding experimental and pharmacoepidemiologic work. Regarding SSRI adverse effects, the most reported undesirable effects referring to driving impairment were anxiety, agitation, sleep disturbances, headache, increased risk of suicidal behavior, and deliberate self-harm. Regarding the remaining issues addressed in this article, inconsistencies were found between the outcomes of the selected experimental and epidemiologic studies and between the 2 existing categorization systems under evaluation. Some pitfalls of the current legislative scenario were identified as well. CONCLUSIONS Based on the current evidence, it was concluded that more experimental and epidemiologic research is needed to elucidate the relationship between SSRI use and traffic safety. Furthermore, a revision of the existing categorization systems and harmonized European legislation in the field of medication use and driving were highly recommended.

A European approach to categorizing medicines for fitness to drive: outcomes of the DRUID project: Medicines and fitness to drive

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

A European approach to categorizing medicines for fitness to drive

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Road traffic accidents and psychotropic medication use in the Netherlands: a case-control study: Medicines and traffic accidents: a case-control study in the Netherlands

AIM To examine the association between the use of commonly prescribed psychotropic medications and road traffic accident risk. METHODS A record-linkage database was used to perform a case-control study in The Netherlands. The data came from three sources: pharmacy prescription data, police traffic accident data and driving licence data. Cases were defined as drivers, who had a traffic accident that required medical assistance between 2000 and 2007. Controls were defined as adults, who had a driving licence and had no traffic accident during the study period. Four controls were matched for each case. The following psychotropic medicine groups were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants stratified in the two groups, SSRIs and other antidepressants. Various variables, such as age, gender, medicine half-life and alcohol use, were considered for the analysis. RESULTS Three thousand nine hundred and sixty-three cases and 18,828 controls were included in the case-control analysis. A significant association was found between traffic accident risk and exposure to anxiolytics (OR = 1.54, 95% CI 1.11, 2.15), and SSRIs (OR = 2.03, 95% CI 1.31, 3.14). A statistically significant increased risk was also seen in chronic anxiolytic users, females and young users (18 to 29 years old), chronic SSRI users, females and middle-aged users (30 to 59 years old), and intermediate half-life hypnotic users. CONCLUSIONS The results of this study support previous findings and confirm that psychoactive medications can constitute a problem in traffic safety. Both health care providers and patients should be properly informed of the potential risks associated with the use of these medicines.