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Salomoni M, Missanelli A, Crescioli G, Lanzi C, Totti A, Losso L, Gitto S, Bonaiuti R, Vannacci A, Lombardi N, Mannaioni G. Real-world analysis on the use of gamma-hydroxybutyric acid for alcohol withdrawal syndrome in hospitalized patients with diagnosis of cirrhosis. Intern Emerg Med 2025; 20:119-129. [PMID: 39249626 PMCID: PMC11794374 DOI: 10.1007/s11739-024-03761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Abstract
The present real-world analysis aimed to evaluate and describe the use of gamma-hydroxybutyric acid (GHB) for alcohol withdrawal syndrome (AWS) in hospitalized patients with diagnosis of liver cirrhosis. An 11-year observational retrospective study on patients affected by liver cirrhosis and alcohol use disorder (AUD) was performed using data from the Medical Toxicology Unit of Careggi University Hospital in Florence (Italy). A multivariate logistic regression was performed to estimate the probability of having a CIWA-Ar Max 3-4 during hospitalization, an AWS length > 36 h, a hospitalization > 9 days, and the probability of developing drowsiness. A total of 166 AUD patients were included, of these 77 received GHB (70.13% within the first day of hospitalization) and 89 were treated without GHB. The majority were ≥ 40 years of age (87.35%) and males (80.12%). GHB patients were more likely to have a CIWA-Ar Max 3-4 during hospitalization (OR 3.76 [CI 95% 1.02-13.85]), and a longer hospitalization (OR 3.08 [95% CI 1.23-7.71]). Early GHB administration decreased the probability of CIWA-Ar Max worsening (OR 0.06 [95% CI 0.01-0.49]). GHB dose ≥ 100 mg/kg was not associated with the occurrence of drowsiness. Patients exposed to other sedative agents were more likely to experience drowsiness (OR 7.22 [95% CI 1.46-35.61]). The present real-world analysis underlines that GHB could be a valuable and safe option for the management of AWS in AUD patients affected by liver cirrhosis, also when administered early and even at higher than recommended dosages.
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Affiliation(s)
- Monica Salomoni
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Andrea Missanelli
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.
| | - Cecilia Lanzi
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Arianna Totti
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Lorenzo Losso
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Guido Mannaioni
- Toxicology Unit and Poison Control Center, Careggi University Hospital, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
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Milella MS, Petraccia L, Pirelli F, Foti G, Sapio M, Berardi R, Caprioli D, Pugliese F, Vivino G. Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022. Pharmacoepidemiol Drug Saf 2024; 33:e5767. [PMID: 38357800 DOI: 10.1002/pds.5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. METHODS Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. RESULTS A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. CONCLUSION Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.
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Affiliation(s)
- Michele Stanislaw Milella
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Francesca Pirelli
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Foti
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Maria Sapio
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Rosaria Berardi
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Daniele Caprioli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Gabriella Vivino
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
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Crescioli G, Maggini V, Raschi E, Gonella LA, Luxi N, Ippoliti I, Di Giovanni V, Bonaiuti R, Firenzuoli N, Gallo E, Menniti-Ippolito F, Moretti U, Trifirò G, Vannacci A, Firenzuoli F, Lombardi N. Suspected adverse reactions to medications and food supplements containing Serenoa repens: A worldwide analysis of pharmacovigilance and phytovigilance spontaneous reports. Phytother Res 2023; 37:5289-5299. [PMID: 37463655 DOI: 10.1002/ptr.7960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
The safety of Serenoa repens (SR)-containing products was evaluated conducting a retrospective worldwide analysis of pharmaco- and phytovigilance report forms of suspected adverse reactions (SARs) collected up to 31 January 2022. Multivariate logistic regression was performed to estimate the odds ratios (ORs) of serious SAR. A total of 1810 report forms were analysed; 92% of subjects were males, with a median age of 69 years; 44% of cases were defined as serious. Subjects exposed to dietary supplements had a higher risk of developing serious SARs (OR: 1.60 [95% CI: 1.20-2.15]), as subjects exposed to 2-5 (OR: 1. 83 [95% CI: 1.30-2.58]) or more than 5 (OR: 3.45 [95% CI: 2.36-5.06]) suspect/interacting products. The probability of experiencing serious SAR was higher for subjects exposed to concomitant products (OR: 1.55 [95% CI: 1.15-2.08]), to more than four active compounds (OR: 4.38 [95% CI: 3.21-5.99]) and to SR for more than 14 days (OR: 1.89 [95% CI: 1.10-3, 22]), and lower for subjects exposed to higher doses of SR (OR: of 0.34 [95% CI: 0.20-0.58]). This evidence improves awareness on safety of SR containing products, suggesting the need of a further update of periodic reviews by national and international regulatory agencies.
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Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Valentina Maggini
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Nicoletta Luxi
- Department of Medicine, University of Verona, Verona, Italy
| | - Ilaria Ippoliti
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | | | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Niccolò Firenzuoli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Eugenia Gallo
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy
| | | | - Ugo Moretti
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Fabio Firenzuoli
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
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Soyka M, Wild I, Caulet B, Leontiou C, Lugoboni F, Hajak G. Long-term use of benzodiazepines in chronic insomnia: a European perspective. Front Psychiatry 2023; 14:1212028. [PMID: 37599882 PMCID: PMC10433200 DOI: 10.3389/fpsyt.2023.1212028] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Chronic insomnia occurs in ~10% of the general population and has numerous negative health effects. The recommended first line treatment of cognitive behavior therapy for insomnia is not widely available for patients in Europe, so pharmacotherapies such as benzodiazepine receptor agonist agents (benzodiazepines and Z-drugs) are commonly used. However, their use is only recommended for ≤4 weeks due to unproven long-term efficacy in treatment of chronic insomnia, and the risk of tolerance, and the potential for dependence and misuse. In Europe, recommendations limiting the use of benzodiazepines (lowest dose and shortest duration) in chronic insomnia are not always followed, likely due to the lack of approved effective alternative therapies. Here we present a recent pilot survey of the pharmacological treatment landscape in chronic insomnia in five European countries (France, Germany, Italy, Spain, and the United Kingdom) and physicians' attitude toward treatment. The results suggest that benzodiazepines and Z-drugs are the most widely used treatments in chronic insomnia and are being used for longer than their recommended duration. Country variations in prescription rates were observed. Due to the known association between long-term benzodiazepine use and potential for developing dependence, further analysis of the literature was performed on the use and misuse of benzodiazepines. The results show that long-term use of benzodiazepines is associated with multiple consequences of treatment, including dependence, but also that previous use of benzodiazepines may increase the risk of opioid use disorder.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Imane Wild
- Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy
| | - Göran Hajak
- University of Regensburg, Regensburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
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Hospitalisations Related to the Combination of ACE Inhibitors and/or Angiotensin Receptor Blockers with Diuretics and NSAIDs: A Post Hoc Analysis on the Risks Associated with Triple Whammy. Healthcare (Basel) 2023; 11:healthcare11020238. [PMID: 36673605 PMCID: PMC9858958 DOI: 10.3390/healthcare11020238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
This post hoc analysis aimed to assess and characterise adverse events (AEs) related to the triple whammy (i.e., combination therapy of ACE inhibitors, ACE-I, and/or angiotensin receptor blockers, ARBs, with diuretics and non-steroidal anti-inflammatory drugs, NSAIDs) leading to emergency department (ED) visits and/or hospitalisations in the Italian setting. The MEREAFaPS database was analysed. ED visits related to co-treatment with ACE-I and/or ARBs, diuretics, and NSAIDs were considered. Information on the AE (including classification, seriousness, and outcome), suspected and concomitant drugs, and concomitant conditions was retrieved and analysed. Logistic regression was used to estimate the reporting odds ratios (RORs) of hospitalisation associated with the drugs of interest. Between 1 January 2007, and 31 December 2018, 80 patients visited the ED for AEs related to the triple whammy, and a total of 261 suspected drugs were involved. Patients were mostly Caucasian females, with a median age of 85 years, and only 9 of them had renal manifestations. In this subset, drug-drug interaction contributed to kidney injury. Most patients presented a Charlson comorbidity index of 4-5. Overall, 47 patients were hospitalised (58.75%), but no significant differences in the risk of hospitalisation were found according to demographic, clinical, or therapeutic features.
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