Risk of cardiovascular events according to the tricyclic antidepressant dosage in patients with chronic pain: a retrospective cohort study
- Authors
- Koo, Hyunji; You, Seung Hun; Park, Sewon; Jeong, Kyeong Hye; Jeon, Nakyung; Jung, Sun-Young
- Issue Date
- Jan-2023
- Publisher
- Springer Science and Business Media Deutschland GmbH
- Keywords
- Cardiovascular adverse events; Chronic pain; Low dose; Tricyclic antidepressants
- Citation
- European Journal of Clinical Pharmacology, v.79, no.1, pp 159 - 171
- Pages
- 13
- Journal Title
- European Journal of Clinical Pharmacology
- Volume
- 79
- Number
- 1
- Start Page
- 159
- End Page
- 171
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/69513
- DOI
- 10.1007/s00228-022-03421-z
- ISSN
- 0031-6970
1432-1041
- Abstract
- Purpose: We aimed to examine the risk of cardiovascular adverse events by tricyclic antidepressant (TCA) dosage among patients with chronic pain. Methods: A retrospective cohort study was conducted using a nationwide sample cohort. Among patients aged ≥ 18 years with a chronic pain diagnosis and no history of cardiovascular events, we extracted users and non-users of TCAs through 1:1 propensity score matching. TCA users were categorized into three groups according to the mean defined daily dose (DDD): very low doses (< 0.15 DDD), low doses (0.15–0.34 DDD), and traditional doses (≥ 0.34 DDD). A 6-month follow-up was conducted with an intention-to-treat approach. We examined the hazard ratio of cardiovascular adverse events using Cox proportional hazards analysis. Results: In total, 16,660 matched patients were followed up (8330 TCA users and 8330 non-users). TCA use did not significantly increase cardiovascular adverse events (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.94–1.33). Low-dose (0.15–0.34 DDD) TCAs (HR 1.37, 95% CI 1.08–1.74), particularly low-dose (0.15–0.34 DDD) nortriptyline (HR 2.11, 95% CI 1.44–3.08), was associated with an increased risk of cardiovascular adverse events. Administration of TCAs at the traditional dose (≥ 0.34 DDD) increased the risk of ischemic stroke (HR 2.08, 95% CI 1.11–3.88). Conclusion: Close monitoring of patients on long-term, low-dose use of TCAs should be conducted to avoid an increase in the cumulative dose, which increases the risk of cardiovascular adverse events. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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