Open AccessTricyclic Antidepressants: Is Your Patient Taking Them? Observations on Adherence and Unreported Use Using Prescriber‐Reported Medication Lists and Urine Drug Testing
Author(s) -
Bordson Sophie J.,
Atayee Rabia S.,
Ma Joseph D.,
Best Brookie M.
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12300
Subject(s) - nortriptyline , medicine , amitriptyline , tricyclic , medical prescription , population , urine , pharmacology , environmental health
Objective Tricyclic antidepressants ( TCA s) are first‐line treatment for neuropathic pain. Despite widespread use, many health care providers do not know which patients are currently taking TCA s. The objective of this retrospective data analysis was to determine adherence rates to amitriptyline, nortriptyline, or imipramine. The rate at which patients used TCA s (confirmed by presence of TCA in the urine) but did not inform their health care provider is also reported (non‐informed prescriber rate). Finally, the effects of age, sex, and number of prescriptions on adherence and non‐informed prescriber rates were assessed. Methods Urinary excretion data were obtained from 55,296 patients with pain and were analyzed using liquid chromatography tandem mass spectrometry in a multiplex assay which included amitriptyline, nortriptyline, and imipramine. Results The adherence rate was 66% (1,407/2,137); the rate of non‐informed prescribers was 3% (1,547/55,296) among the general population, and 52% (1,547/2,954) when only TCA users were considered. While adherence was higher among older and female subjects, the number of other medications did not affect adherence rate. Conclusions This analysis reveals that many prescribers are not informed when patients start and stop using TCA s.