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Flupentixol use and adverse reactions in comparison with other common first- and second-generation antipsychotics: data from the AMSP study

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Abstract

This study compares the first-generation antipsychotic (FGA) flupentixol to haloperidol and common second-generation antipsychotics (SGAs) as to drug utilization and severe adverse drug reactions (ADRs) in clinical treatment of schizophrenia inpatients using data from the drug safety program Arzneimittelsicherheit in der Psychiatrie (AMSP). AMSP drug utilization and reported ADR data were analyzed. Type and frequency of severe ADRs attributed to flupentixol were compared with haloperidol, clozapine, olanzapine, quetiapine, risperidone and amisulpride in a total of 56,861 schizophrenia inpatients exposed to these drugs. In spite of increasing prescription of SGAs, flupentixol was consistently used in schizophrenic inpatients (about 5 %) over time. Reporting rates of severe ADR ranged from 0.38 to 1.20 % for the individual antipsychotics (drugs imputed alone); flupentixol ranked lowest. The type of ADR differed considerably; as to severe EPMS, flupentixol (0.27 %), such as risperidone (0.28 %), held an intermediate position between haloperidol/amisulpride (0.55/0.52 %) and olanzapine/quetiapine (<0.1 %). The study is a heuristic approach, not a confirmatory test. Flupentixol has a stable place in the treatment of schizophrenia in spite of the introduction of different SGAs. Comparative ADR profiles suggest an intermediate position between FGAs and SGAs for flupentixol in clinical practice.

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Conflict of interest

The AMSP Drug Safety Program is organized by non-profit associations in Germany, Austria and Switzerland. AMSP has been supported with unrestricted educational and research grants since 1993 by the following companies:

Austrian companies

Astra Zeneca Österreich GmbH, Boehringer Ingelheim Austria, Bristol-Myers Squibb GmbH, CSC Pharmaceuticals GmbH, Eli Lilly GmbH, Germania Pharma GmbH, GlaxoSmithKline Pharma GmbH, Janssen-Cilag Pharma GmbH, Lundbeck GmbH, Novartis Pharma GmbH, Pfizer Med Inform, Wyeth Lederle Pharma GmbH.

German companies

Abbott GmbH & Co. KG, AstraZeneca GmbH, Aventis Pharma Deutschland GmbH GE–O/R/N, Bayer Vital GmbH, Boehringer Mannheim GmbH, Bristol-Myers-Squibb, Ciba Geigy GmbH, Desitin Arzneimittel GmbH, Duphar Pharma GmbH & Co. KG, Eisai GmbH, esparma GmbH Arzneimittel, GlaxoSmithKline Pharma GmbH & Co. KG, Hoffmann-La Roche AG Medical Affairs, Janssen-Cilag GmbH, Janssen Research Foundation, Knoll Deutschland GmbH, Lilly Deutschland GmbH Niederlassung Bad Homburg, Lundbeck GmbH & Co. KG, Novartis Pharma GmbH, Nordmark Arzneimittel GmbH, Organon GmbH, Otsuka-Pharma Frankfurt, Pfizer GmbH, Pharmacia & Upjohn GmbH, Promonta Lundbeck Arzneimittel, Rhone-Poulenc Rohrer, Sanofi-Synthelabo GmbH, Sanofi-Aventis Deutschland, Schering AG, SmithKline Beecham Pharma GmbH, Solvay Arzneimittel GmbH, Synthelabo Arzneimittel GmbH, Dr. Wilmar Schwabe GmbH & Co., Thiemann Arzneimittel GmbH, Troponwerke GmbH & Co. KG, Upjohn GmbH, Wander Pharma GmbH, Wyeth-Pharma GmbH.

Swiss companies

AHP (Schweiz) AG, AstraZeneca AG, Bristol-Myers Squibb AG, Desitin Pharma GmbH, Eli Lilly (Suisse) S.A., Essex Chemie AG, GlaxoSmithKline AG, Janssen-Cilag AG, Lundbeck (Suisse) AG, Organon AG, Pfizer AG, Pharmacia, Sanofi-Aventis (Suisse) S.A., Sanofi-Synthélabo SA, Servier SA, SmithKlineBeecham AG, Solvay Pharma AG, Wyeth AHP (Suisse) AG, Wyeth Pharmaceuticals AG.

Disclaimer statements

R.R. Engel: no conflict of interest to be declared; R. Grohmann is a project manager of AMSP; H.-J. Möller has received grants or is a consultant for and on the speakership bureaus of AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Novartis, Organon, Pfizer, Sanofi-Aventis, Schering-Plough, Schwabe, Sepracor, Servier and Wyeth; E. Rüther has received research grants from Lilly, Lundbeck, BMS, Astra Zeneca; and Bayer and is a consultant for and on the speakership bureaus of Servier, Otsuka, Lundbeck, Wyeth and Lilly; S. Stübner: no conflict of interest to be declared; J.W. van der Velden is pharmacoepidemiology consultant to AMSP and for companies and regulatory authorities. For this study, no conflict of interested is to be declared.

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Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, Ludwig-Maximilians University, Nussbaumstraße 7, 80336, Munich, Germany

    R. Grohmann, R. R. Engel, H.-J. Möller, E. Rüther & S. Stübner

  2. Postgraduate Programme in Pharmaceutical Medicine, Université Libre de Bruxelles, Brussels, Belgium

    J. W. van der Velden

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  1. R. Grohmann
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  2. R. R. Engel
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  3. H.-J. Möller
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  4. E. Rüther
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  5. J. W. van der Velden
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  6. S. Stübner
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Correspondence to R. Grohmann.

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Grohmann, R., Engel, R.R., Möller, HJ. et al. Flupentixol use and adverse reactions in comparison with other common first- and second-generation antipsychotics: data from the AMSP study. Eur Arch Psychiatry Clin Neurosci 264, 131–141 (2014). https://doi.org/10.1007/s00406-013-0419-y

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  • DOI: https://doi.org/10.1007/s00406-013-0419-y

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