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OBJECTIVE: To compare the use of drugs for pulmonary diseases in children who were exposed to antidepressants in utero with non-exposed children. Some studies suggest an association between in utero exposure to antidepressants and the occurrence of pulmonary diseases later in life. Antidepressants are thought to be involved in the development of the respiratory rhythm generator and the maturation of surfactant formation. DESIGN AND METHODS: The pharmacy prescription database IADB.nl was used for a cohort study. The use of drugs for pulmonary diseases in children after in utero exposure to antidepressants was compared to children with no antidepressant exposure in utero. Drugs for pulmonary diseases were applied as a proxy for disturbed development of the respiratory tract. RESULTS: A small but significant increase in the incidence risk ratio (IRR) of the use of drugs for pulmonary diseases was found after anytime in utero exposure to serotonin reuptake inhibitors (SSRIs) (1.17; CI951.16-1.18). IRR also was increased for specific use of SSRIs in the first trimester (1.18; CI951.17-1.20). IRR increase for children who were exposed to tricyclic antidepressants was not statistically significant. As sample size was rather small in both groups, the effect size is modest and may also be confounded by maternal smoking. CONCLUSIONS: Children exposed to SSRIs in utero use significantly more drugs for pulmonary diseases, especially when exposure occurred during the first trimester of pregnancy. However, the increased use of such drugs may also be related to other factors.

OBJECTIVE: To compare the use of drugs for pulmonary diseases in children who were exposed to antidepressants in utero with non-exposed children. Some studies suggest an association between in utero exposure to antidepressants and the occurrence of pulmonary diseases later in life. Antidepressants are thought to be involved in the development of the respiratory rhythm generator and the maturation of surfactant formation. DESIGN AND METHODS: The pharmacy prescription database IADB.nl was used for a cohort study. The use of drugs for pulmonary diseases in children after in utero exposure to antidepressants was compared to children with no antidepressant exposure in utero. Drugs for pulmonary diseases were applied as a proxy for disturbed development of the respiratory tract. RESULTS: A small but significant increase in the incidence risk ratio (IRR) of the use of drugs for pulmonary diseases was found after anytime in utero exposure to serotonin reuptake inhibitors (SSRIs) (1.17; CI951.16-1.18). IRR also was increased for specific use of SSRIs in the first trimester (1.18; CI951.17-1.20). IRR increase for children who were exposed to tricyclic antidepressants was not statistically significant. As sample size was rather small in both groups, the effect size is modest and may also be confounded by maternal smoking. CONCLUSIONS: Children exposed to SSRIs in utero use significantly more drugs for pulmonary diseases, especially when exposure occurred during the first trimester of pregnancy. However, the increased use of such drugs may also be related to other factors.

Recently, two importance articles about St. John's wort (Hypericum perforatum) appeared in the medical literature: a randomised clinical trial comparing St. John's wort with placebo and imipramine and a commentary about interactions between St. John's wort and registered medicines. These publications are discussed in the broader perspective of a benefit-risk assessment.

Recently, two importance articles about St. John's wort (Hypericum perforatum) appeared in the medical literature: a randomised clinical trial comparing St. John's wort with placebo and imipramine and a commentary about interactions between St. John's wort and registered medicines. These publications are discussed in the broader perspective of a benefit-risk assessment.

Objective: To collect data of toxicological cases for a 10-year period and to develop a database for comparing epidemiology of intoxications with data from the national poisoning information centre (NVIC) and national prescription data (GIP). Design: Retrospective database study. Methods: All drug intoxications between 1997 and 2006 were identified from the records of the Clinical Pharmaceutical and Toxicological Laboratory in The Hague, Netherlands. Patient demographics and details of drugs analysed were acquired. These data were compared with data from NVIC and GIP. Results and conclusion: Almost 6000 cases were reviewed. From 1997 to 2006 the number of toxicological cases in The Hague increased from 322 to 826 per year. From 2001-2005 >90% of toxicological cases comprised analgesics, antidepressants, antipsychotics and hypnotics. These drugs comprised 60-70% of cases reported to the PIC and 10-12% of prescriptions. Most drug intoxications in The Hague involved analgesics and psychopharmacologic drugs. Relative to prescription data, most intoxications occur with tricyclic antidepressants. There seems to be an imbalance between number of intoxications and prescriptions among SSRIs: citalopram is relatively more involved in intoxications than the other SSRIs, but more research is needed to confirm this.

Objective: To collect data of toxicological cases for a 10-year period and to develop a database for comparing epidemiology of intoxications with data from the national poisoning information centre (NVIC) and national prescription data (GIP). Design: Retrospective database study. Methods: All drug intoxications between 1997 and 2006 were identified from the records of the Clinical Pharmaceutical and Toxicological Laboratory in The Hague, Netherlands. Patient demographics and details of drugs analysed were acquired. These data were compared with data from NVIC and GIP. Results and conclusion: Almost 6000 cases were reviewed. From 1997 to 2006 the number of toxicological cases in The Hague increased from 322 to 826 per year. From 2001-2005 >90% of toxicological cases comprised analgesics, antidepressants, antipsychotics and hypnotics. These drugs comprised 60-70% of cases reported to the PIC and 10-12% of prescriptions. Most drug intoxications in The Hague involved analgesics and psychopharmacologic drugs. Relative to prescription data, most intoxications occur with tricyclic antidepressants. There seems to be an imbalance between number of intoxications and prescriptions among SSRIs: citalopram is relatively more involved in intoxications than the other SSRIs, but more research is needed to confirm this.

Objective: To assess whether concerns and problems experienced with drug discontinuation occur more frequently in patients using antidepressants than in patients using benzodiazepines, antipsychotics or non-psychiatric medication. Clinical trials and epidemiological studies have shown that premature discontinuation is a major problem during antidepressant therapy. There is little information on how patients perceive treatment with antidepressants in clinical practice, and it is unclear whether patients perceive discontinuation as a problem. Design and methods: All calls to a Dutch national telephone medicines infotmation service received between 1990 and 2004 were examined retrospectively. Calls about discontinuation were identified and classified either as a genetal question about discontinuation, or as a problem experienced with discontinuation. These calls were grouped into four main classes: antidepressants, antipsychotics, benzodiazepines or non-psychiatric medicines. Results: Of all 39,786 registered phone calls, 6,159 (15-5%) related to antidepressants, 1,658 (4.2%) to antipsychotics and 3,916 (9.8%) to benzodiazepines. Patients calling about antidepressants called about discontinuation three times as often [odds ratio (OR) 2.8; 95% confidence interval (CI95) 2.6-3.0], and reported a problem with discontinuation five times more often (OR 5.4; CI95 4,6-6.3) than patients who called about non-psychiatric medicines. The proportion of questions about discontinuation and problems experienced with discontinuation was also higher in patients calling about benzodiazepines and antipsychotics than in patients calling about non-psychiatric medication. Conclusion: Patients perceive discontinuation of antidepressants, as well as discontinuation of antipsychotics and benzodiazepines, as a problem. Discontinuation seems a general problem for all psychiatric medicines, and needs more attention in the communication between patients and healthcare providers.

Objective: To assess whether concerns and problems experienced with drug discontinuation occur more frequently in patients using antidepressants than in patients using benzodiazepines, antipsychotics or non-psychiatric medication. Clinical trials and epidemiological studies have shown that premature discontinuation is a major problem during antidepressant therapy. There is little information on how patients perceive treatment with antidepressants in clinical practice, and it is unclear whether patients perceive discontinuation as a problem. Design and methods: All calls to a Dutch national telephone medicines infotmation service received between 1990 and 2004 were examined retrospectively. Calls about discontinuation were identified and classified either as a genetal question about discontinuation, or as a problem experienced with discontinuation. These calls were grouped into four main classes: antidepressants, antipsychotics, benzodiazepines or non-psychiatric medicines. Results: Of all 39,786 registered phone calls, 6,159 (15-5%) related to antidepressants, 1,658 (4.2%) to antipsychotics and 3,916 (9.8%) to benzodiazepines. Patients calling about antidepressants called about discontinuation three times as often [odds ratio (OR) 2.8; 95% confidence interval (CI95) 2.6-3.0], and reported a problem with discontinuation five times more often (OR 5.4; CI95 4,6-6.3) than patients who called about non-psychiatric medicines. The proportion of questions about discontinuation and problems experienced with discontinuation was also higher in patients calling about benzodiazepines and antipsychotics than in patients calling about non-psychiatric medication. Conclusion: Patients perceive discontinuation of antidepressants, as well as discontinuation of antipsychotics and benzodiazepines, as a problem. Discontinuation seems a general problem for all psychiatric medicines, and needs more attention in the communication between patients and healthcare providers.

Data from 134 patients who were treated with clozapine are analysed in order to determine the influence of age, gender and comedication on the pharmacokinetics of clozapine. Serum concentration was corrected for the daily dose administered. Female patients had a statistically significant higher corrected serum concentration of clozapine than male patients. In female patients, corrected serum concentration tended to increase from

Data from 134 patients who were treated with clozapine are analysed in order to determine the influence of age, gender and comedication on the pharmacokinetics of clozapine. Serum concentration was corrected for the daily dose administered. Female patients had a statistically significant higher corrected serum concentration of clozapine than male patients. In female patients, corrected serum concentration tended to increase from