Steven Dubovsky, MD

Prescribers should be mindful of the risks for adverse reactions with psychiatric drugs, especially antipsychotics, lithium, and zolpidem.

About 12% of the U.S. population takes prescription psychiatric medications, but the comparative risks for nonintentional adverse drug reactions (ADRs) for each drug class have been little studied. To learn more, researchers examined 3 years of electronic records of adult visits to emergency departments (EDs) at 63 hospitals.

Of 89,094 ED visits for psychiatric ADRs (about 10% of all ADR visits to EDs), almost 20% resulted in hospitalization. The highest rate of ED visits relative to the number of outpatient presumed prescriptions was found for antipsychotics (especially, typical antipsychotics), primarily for severe extrapyramidal effects, and lithium, with the most common problems being “abnormal drug level,” altered mental status, and movement disorder. In an examination of individual drugs, zolpidem led to more ED visits than any other psychiatric medication, especially in older patients. The analyses did not include anticonvulsants.

Citation(s):

Hampton LM et al. Emergency department visits by adults for psychiatric medication adverse events. JAMA Psychiatry 2014 Jul 9; [e-pub ahead of print].