Prescription Patterns and Safety Monitoring Practices in Medication for Youths with Attention-deficit/Hyperactivity Disorder

兒童青少年過動症的藥物處方與安全監測

吳洽明(Chia-Ming Wu)；鄭淑文(Shu-Wen Cheng)；陳質采(Chih-Tsai Chen)；許元彰(Yuan-Chang Hsu)；宋成賢(Cheng-Hsien Sung)；劉士愷(Shih-Kai Liu)；李國平(Kuo-Ping Li)

attention-deficit/hyperactivity disorder (ADHD) ； youths ； prescription pattern ； medication safety ； 注意力不足過動症 ； 兒童青少年 ； 處方型態 ； 用藥安全

台灣精神醫學

32卷4期（2018 / 12 / 01）

294 - 305+i

英文

Objective: As the use of methylphenidate and atomoxetine in youths with Attention-deficit/hyperactivity disorder (ADHD) is increasing, medication safety is important. We intended to study the prescription patterns and safety monitoring practices of pharmacological treatment in ADHD youths. Methods: We enrolled patients who were younger than 18 years with the diagnosis of ADHD, visited our clinics, and had been prescribed immediate-release formulation of methylphenidate (IR-MPH), osmotic release oral system formulation of methylphenidate (OROS-MPH) or atomoxetine from January 1, 2013 to December 31, 2013. We sampled 100 persons in each IR-MPH and OROS-MPH groups and included all 35 patients in atomoxetine group due to limited numbers. Both electronic medical records and chart review were done to evaluate the characteristics of patients, to monitor adverse effects and the efficacy of treatment in clinical practice. Results: Totally, 84.7% of these 235 persons were male; the mean age (11.3 ± 2.6 years) was significantly lower in IR-MPH group. The rates of monitoring the adverse effect of the neuropsychiatric system, cardiovascular system, growth, body weight and appetite during medication ranged from 6% to 27%. No significant difference noted in EKG check, chart record of monitoring for adverse drug reactions, and drug interaction among three groups; a significant higher rate of efficacy reported in IR-MPH and OROS-MPH groups. Conclusion: Based on this of study finding, we suggest that we need to enhance the monitoring of cardiovascular condition, neuropsychiatric side effects, growth, body weight and appetite during treatment for patients with ADHD.

目的：探討兒童青少年注意力不足過動症患者藥物治療的處方模式與臨床安全監測情況。方法：以2013年1月至2013年12月期間於某一精神科專科醫院門診就醫，經診斷為未滿十八歲注意力不足過動症病人，並選擇最常見的三種處方藥物，即立即釋放型methylphenidate (IR-MPH)、口服滲透壓釋放劑型methylphenidate (OROS-MPH)和atomoxetine來探討。在IR-MPH與OROS-MPH這兩組隨機各取樣100名個案，但由於使用atomoxetine的個案數有限，故35名個案全數納入。以回顧紙本及電子醫療記錄來評估患者的特質、副作用監測以及療效的臨床操作狀況。結果：總共235人中，84.7%是男性；IR-MPH組的平均年齡（11.3±2.6歲）顯著較低。在藥物治療期間，神經精神系統，心血管系統，生長，體重和食慾的不良反應監測比率為6%至27%。EKG檢查，不良藥物反應監測的病歷記錄和藥物相互作用三組間沒有顯著差異；IR-MPH和OROS-MPH組的療效報告顯著較佳。結論：本研究顯示治療期間心血管狀況、神經精神副作用、發育、體重與食慾的監測記錄應加強。

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