Adverse Psychiatric Reactions Information Link
Promoting awareness of medicines that can harm mental health

For Prescribers of medicines

   

Personalised Medicine 

 At last in March 2022 a promise for Personalised Medication Prescribing. This should dramatically reduce harm done to many by using medication they cannot tolerate, or does nothing to improve their condition.

Recommendations on DPD testing prior to treatment with fluorouracil, capecitabine, tegafur and flucytosine

NHS ENGLAND

Clinical Commissioning Urgent Policy Statement Pharmacogenomic testing for DPYD polymorphisms with fluoropyrimidine therapies [URN 1869] (200603P)

https://www.england.nhs.uk/wp-content/uploads/2020/11/1869-dpyd-policy-statement.pdf

Pharmacogenomic testing for DPYD polymorphisms which cause dihydropyrimidine dehydrogenase (DPD) deficiency is recommended to be available through routine commissioning as a pre-treatment screening test prior to the administration of fluoropyrimidinebased therapies through routine commissioning within the criteria set out in this document. Information about pharmacogenomic testing for DPYD polymorphisms with fluoropyrimidine therapies

On 30 April 2020, EMA recommended that patients should be tested for the lack of the enzyme dihydropyrimidine dehydrogenase (DPD) before starting cancer treatment with fluorouracil given by injection or infusion (drip) or with the related medicines, capecitabine and tegafur.

As treatment for severe fungal infections with flucytosine (another medicine related to fluorouracil) should not be delayed, testing patients for DPD deficiency before they start treatment is not required.

Patients who completely lack DPD must not be given any fluorouracil medicines. For patients with partial deficiency, the doctor may consider starting cancer treatment at lower doses than normal or stoppingflucytosine treatment if severe side effects occur.

https://www.england.nhs.uk/wp-content/uploads/2020/11/1869-dpyd-policy-statement.pdf

 

Personalised Medicine 

 At last in March 2022 a promise for Personalised Medication Prescribing. This should dramatically reduce harm done to many by using medication they cannot tolerate, or does nothing to improve their condition.

A Detailed report just published March 2022 by the 
Royal College of Physicians & British Pharmacological Society -

Click Here for the Report: PERSONALISED PRESCRIBING

An article in The Guardian Experts push for genetic testing to personalise drug prescriptions explains the benefits, as About 6.5% of UK hospital admissions are caused by adverse drug reactionswhile most prescription medicines only work on 30% to 50% of people.
Click here for the Guardian article by Linda Geddes:

APRIL has been promoting the use of genetic testing for many years  - Click here for a talk by Professor Sir Munir Pirmohamed, Chair of the Working Group on Personalised Prescribing, speaking at our conference

 

 

 

 

 

DOCTORS - NURSES - PSYCHIATRISTS & Non Medical Prescribers IMPORTANT INFORMATION about iatrogenic psychiatric adverse drug reactions. Many medicines you may have prescribed CAN CAUSES DEPRESSION AND EVEN LEAD TO SUICIDE.

Professor Munir Pirmohamed and other researchers statedIn recent years there has been growing concern that certain prescribed medicines may be associated with psychiatric adverse drug reactions such as depression, non-fatal self-harm and suicide" Click on the heading for the published research.

Professor Sir Munir Pirmohamed with research colleagues published the following and you can click here for the full paper:

Reporting of drug induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011
Kyla H Thomas1,4*, Richard M Martin1, John Potokar2, Munir Pirmohamed3 and David Gunnell1

In the above research information there is a table showing: Rates of Yellow Card adverse reports per million prescriptions dispensed for the top 20 drugs with the highest number of adverse reports for depressive disorders, non-fatal suicidal behaviour and suicide

Prescribed pharmaceutical medicines include:

Rimonabant Isotretinoin Mefloquine Etonogestrel Sibutramine Levonorgestrel Desogestrel Levetiracetam
Paroxetine Venlafaxine Fluoxetine Citalopram Rimonabant
Isotretinoin Clozapine Atomoxetine Varenicline Duloxetine Paroxetine Levetiracetam Topiramate
Pregabalin Escitalopram Risperidone Mirtazapine Olanzapine Sertraline
Paracetamol Efavirenz Varenicline Duloxetine Aripiprazole  Risperidone  Venlafaxine Olanzapine
Escitalopram Quetiapine Zopiclone Diazepam Amitryptiline

Please read the Royal College of Anaethetists information about 'Delirium and Confusion after Anaesthesia'

Reporting of drug induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011
Kyla H Thomas, Richard M Martin, John Potokar, Munir Pirmohamed and David Gunnell

The Imperial College study as published in the Royal Society of Medicine journal may have escaped your notice.

 

ADR hospital admission statistics to 2010 (as published by the Royal Society of Medicine)

  • Increase in ADR related hospital deaths 10%
  • Emergency admissions in hospitals due to ADRs increased by 76.8% 

If you were unable to attend our conferences, you may still listen to many Professors and academics you will rarely have the opportunity to her...revue this list of speakers

Professor Heather Ashton - expert Clinical Pharmacologist who ran a Benzodiazepine Withdrawal Clinic for Many years and produced the Ashton Manual to help clinicians assist their patients and prevent the harm of too sudden withdrawal from prescribed drugs that cause dependence.

Professor Munir Pirmohamed - expert in the area of Personalised Medicine now being promoted.

                Personalised Medicine - March 2022 Breaking News

 At last in March 2022 a promise for Personalised Medication Prescribing. This should dramatically reduce harm done to many by using medication they cannot tolerate, or does nothing to improve their condition.

A Detailed report just published March 2022 by the 
Royal College of Physicians & British Pharmacological Society -

Click Here for the Report: PERSONALISED PRESCRIBING

Now listen to wise words that could inrease your ability to save suffering here on  videos hosted on our Vimeo site.

Professor Simon Maxwell - Clinical Pharmacologist  is involved in educating medical students and was always concerned about the need for more information about Adverse Drug Reactions.

A new Prescribing Safety Assessment examination for medical students, may ensure some graduates since 2016 will be better prepared than many of their predecessors.

The GMC guidelines on Medical Education 'Tomorrow's Doctors' had excluded Clinical Pharmacology and Therapeutics in the 'Integrated Medicine' model of education since the early 90's. 

https://prescribingsafetyassessment.ac.uk/

 

Emeritus Professor of Anaesthesiology Anita Holdcroft - anaesthetist & academic researcher speaks of a case study in the British Medical Journal of Co-amoxiclav acute psychosis, an adverse drug reactions (ADR) many would have found surprising.

Hear an interesting discussion

with leaders in the field of Medicines Regulation,

Pharmacovigilance,

Clinical Pharmacology,

Anaesthesiology and Psychiatry,

in this eye opening discussion

Andrew Herxheimer renowned Clinical Pharmacologist Founder of the Drug and Therapeutics Bulletin , Professor Joanna Moncrieff, Professor Simon Maxwell , Charles Medawar, Professor David Healy, Dr Anita Holdcroft in a panel session at our last conference.

Andrew Herxheimer was a champion of evidence-based medicine 

Please listen to some or all the wise words of experts in the field of Clinical Pharmacology, anaesthetics, pharmacogenetics

 here on  videos hosted on our Vimeo site. Learn from the valued experience of the above speakers plus Professor David Healy - psychiatrist. Charles Medawar academic researcher - Nigel Meadow, Manchester City Coroner - Dr Ben Goldacre author of Bad Science

Please also read this vital information to prevent harm from
antidepressant prescribing -

Info you must know, direct from the manufacturers, before you prescribe antidepressants, 
especially if your patient is a young person 
or a student living away from home.

WARNING - before you prescribe antidepressants  - Information published in Prescriber Journal

"Please ensure the patient, before and during antidepressant use,
has regular blood tests to 
check potasium levels, kidney and liver function." 

 "You should inform a family member or someone close to the patient before they start taking antidepressants."

Advice from the manufacturers and the Royal Colleges and Department of Health 

Please read the editorial in the medical journal Prescriber: and the D of H Concensus Statement.

The role of relatives and friends in antidepressant treatment - an editorial by Professor of Pharmacy Janet Krska & Millie Kieve

November 2015 editorial in Prescriber journal by Millie Kieve and Professor of Pharmacy Janet Krska

Concensus Statement for Suicide Prevention from Department of Health and Royal Colleges 

 The article explains the need for a family member or friend to be informed when antidepressants are prescribed: entitled The role of relatives and friends in antidepressant treatment:  

 

Continuing Professional Development (CPD)

 CPD may not currently include the kind of questions students are being asked to prepare for in the Prescribing Safety Assessment on line examination. It would be valuable if GPs could be encouraged to review and even add to the value of the examination, by suggesting more questions to be included.

Drug Safety Updates from MHRA click here for latest update and sign up for pdf of updates.

It is not always easy to keep on top of latest developments concerning patient safety. Black triangles may be suddenly designated for drugs you have been prescribing for years. Warning issued by the FDA, EU or MHRA may be missed.

For psychiatric adverse drug reactions and new advice about support for withdrawal from benzodiazepines, Z drugs and antidepressants, the information may not be easy to find.

APRIL hopes the following information will help you in your endeavours to keep your patients safe from harm.

Articles on ResearchGate may be of value

Clinical data for health professionals information more links

Drug regulator Safety Communications, Warnings and Alerts

FDA Index to drug specific information direct link

UK official government drug safety updates direct link

For a quick check of possible neuropsychiatric adverse effects refer to:

The British Journal of Psychiatry Published bimonthly by The Royal College of PsychiatristsBJPsych Advances offers a distillation of current clinical knowledge, written by expert clinicians to meet the CPD needs of consultant psychiatrists.

Journal includes information on treatment of psychiatric side-effects
Nora Turjanski, Geoffrey G. Lloyd
 
 

 

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