Pharmacotherapy for psychiatric inpatients with alcohol use disorder or acute intoxication: results from an observational pharmacovigilance program-status and changes between 2000 and 2016

Abstract

Alcohol use disorder (AUD) is a mental disorder with a high prevalence and is one of the most common diagnoses requiring inpatient treatment. For the pharmacological management of withdrawal and detoxification, tranquilizing and anticonvulsant drugs, as well as symptom-triggered therapy, are recommended. In this study, we investigated the use of psychotropic drugs in the inpatient treatment of patients with AUD or acute intoxication by analyzing data from the Drug Safety Program in Psychiatry (German: Arzneimittelsicherheit in der Psychiatrie; AMSP). Patients were classified according to the ICD-10 code F10. The study included 10,332 patients treated for AUD or acute intoxication in participating hospitals between 2000 and 2016. The most frequently used drug classes were antidepressant (31.2%), antipsychotic (29.7%), anticonvulsant (26.4%) and tranquilizing drugs (24.3%), among which benzodiazepines were the most commonly used (23.6%). The most common drugs were carbamazepine (11.1%), diazepam (10.1%), mirtazapine (8.5%) and oxazepam (8.2%). Treatment patterns varied depending on sex and the presence of additional psychiatric diagnosis, such as depressive disorder. During the observation period, the use of antidepressant and antipsychotic drugs increased and the use of tranquilizing drugs doubled, while the use of clomethiazole declined. These findings underscore the need for greater attention to managing comorbidities. However, we also observed a high utilization of non-benzodiazepine sedating drugs-such as trazodone, mirtazapine and quetiapine-even though there is insufficient evidence to support their use in this context. Further research is warranted.

Keywords: AMSP; Alcohol use disorder; Antidepressant drug; Antipsychotic drug; Pharmacovigilance; Psychiatry; Psychopharmacology.