Evaluation of Kosovo pharmacists’ knowledge of tamoxifen induced psychiatric disorders in comparison with reported side effects in the WHO pharmacovigilance database

Main Article Content

Ardian Rugova https://orcid.org/0009-0006-2839-0356
Sulltane Havolli https://orcid.org/0009-0009-6372-6515
Valon Ejupi https://orcid.org/0000-0002-0367-9878

Keywords

tamoxifen, pharmacovigilance, side effects, psychiatric disorders, kosovo

Abstract

Background: Tamoxifen is a widely prescribed selective estrogen receptor modulator (SERM) used for the treatment and prevention of hormone receptorpositive breast cancer. While tamoxifen has proven effective in lowering the chance of cancer recurrence, current data point to a possible link between tamoxifen treatment and unfavorable psychological consequences. Objective: In this study, the World Health Organization (WHO) pharmacovigilance database will be analyzed to determine the frequency and kind of psychiatric disorders linked to the use of the tamoxifen as well as Kosovo pharmacists’ awareness of these reported adverse effects. Methods: The WHO pharmacovigilance database, VigiBase, was queried for adverse drug reaction reports related to tamoxifen use between 1978 and 2022. A cross-sectional survey of 70 community pharmacies operating in Kosovo was conducted as part of the data collection between January 1 and March 1, 2023, with the goal of comparison. Results: The search of VigiBase yielded a total of 1746 reported cases of psychiatric disorders. The data were further classified based on the type of psychiatric adverse effect, including depressive disorders, anxiety disorders, cognitive impairment, and other psychiatric symptoms. Depressive disorders were the most frequently reported adverse event, accounting for 30% of the cases. Anxiety disorders and sleeps disorders were also prevalent, comprising 11% and 7% of the reported cases, respectively. Other psychiatric symptoms such as mood swings, insomnia, and confusion were observed in 32% of the cases. In Kosovo, 30% of pharmacist’s linked tamoxifen with depression, 25% with anxiety, 56% with sleep disorders, 53% insomnia, and 18% confusion. Conclusions: Based on the WHO pharmacovigilance database and knowledge of Kosovo pharmacists for these documented adverse effects, this study analyzes tamoxifen-induced psychiatric disorders. The findings show how attentive healthcare professionals must be to any potential psychiatric side effects of tamoxifen therapy. The safety and effectiveness of tamoxifen treatment for patinets with breast cancer should be improved with more study into the underlying processes and the development of methods for prevention, early diagnosis, and management of these side effects.

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References

1. Phelan JC, Bromet EJ, Link BG. Psychiatric illnes and family stigma. Scizophrenia Bulletin, 1998; 24(1):115-125. https://doi. org/10.1093/oxfordjournals.schbul.a033304
2. Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival. JAMA 1993; 270(15):1819-25.
3. Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), (https://vizhub.healthdata.org/gbd-results/, accessed March 1, 2023)
4. Mental health atlas 2020. Geneva: World Health Organization; accessed March 1, 2023.
5. Moitra M, Santomauro D, Collins PY, et al. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: a systematic review and Bayesian meta-regression analysis. PLoS Med. 2022;19(2). https://doi.org/10.1371/ journal.pmed.1003901
6. Mezuk B, Eaton WW Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31:2383-2390. https://doi.org/10.2337/dc08-0985
7. Smith KJ, Beland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J. Psychosom Res. 2013;74: 89-99. https://doi.org/10.1016/j.jpsychores.2012.11.013
8. Stubbs B, Vancampfort D, De Hert M, et al. The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatr Scand. 2015;132:144-157. https://doi.org/10.1111/acps.1243
9. Vancampfort D, Mitchell AJ, De Hert M, et al. Prevalence and predictors of type 2 diabetes mellitus in people with bipolar disorder: a systematic review and meta-analysis. J Clin Psychiat. 2015;76:1490-1499. https://doi.org/10.4088/jcp.14r09635
10. Vancampfort D, Rosenbaum S, Ward PB, et al. Type 2 Diabetes Among People With Posttraumatic Stress Disorder: Systematic Review and Meta-Analysis. Psychosom Med. 2016;78:465-473. https://doi.org/10.1097/psy.0000000000000297
11. Correll CU, Solmi M, Veronese N, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16:163-180. https://doi.org/10.1002/wps.20420
12. Ashina S, Serrano D, Lipton RB, et al. Depression and risk of transformation of episodic to chronic migraine. J Headache Pain. 2012;13:615-24. https://doi.org/10.1007/s10194-012-0479-9
13. Freemantle SN, Pearce GL, Wilton LV, et al.The incidence of the most commonly reported events with 40 newly marketed drugs – A study by prescription-event monitoring. Pharmacoepidemiol Drug Saf.1997;6:1–62.
14. Ananth J, Ghadirian AM: Drug-induced mood disorders. Int Pharmacopsychiatry. 1980;15: 59-73.
15. Beers MH, Passman LJ. Antihypertensive medications and depression. Drugs. 1990;40:792-799.
16. Gangat AE, Simpson MA, Naidoo LR. Medication as a potential cause of depression. S Afr Med J. 1986;70:224-226.
17. Ganzini L, Walsh JR, Millar SB. Drug-induced depression in the aged. What can be done? Drugs Aging. 1993;3:147-158. https:// doi.org/10.2165/00002512-199303020-00005
18. Klysner R. Drug-induced depression. Pharmacol Toxicol. 1992;71:107-112.
19. Patten SB, Love EJ. Drug-induced depression. Incidence, avoidance and management. Drug Saf. 1994;10:203-219. https://doi. org/10.2165/00002018-199410030-00003
20. Patten SB, Love EJ. Drug-induced depression. Psychother Psychosom. 1997;66:63-73.
21. Popkin MK, Tucker GJ. ‘Secondary’ and drug-induced mood, anxiety, psychotic, catatonic, and personality disorders: A review of the literature. J Neuropsychiatry Clin Neurosci. 1992;4:369-385. https://doi.org/10.1176/jnp.4.4.369
22. Wood KA, Harris MJ, Morreale A, et al. Drug-induced psychosis and depression in the elderly. Psychiatr Clin North Am. 1988;11:167-193.
23. Isaacs C, Wellstein A, Riegel. Hormones and related agents in the therapy of cancer. In: Brunton L, Hilal-Dandan R, Knollmann BC (eds) Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 13th edn. Mc Graw Hill Medical, New York, pp 1237-1247; 2018
24. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: Current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97:1652-1662. https://doi.org/10.1093/jnci/ dji372
25. Bushnell CD, Goldstein LB. Risk of ischemic stroke with tamoxifen treatment for breast cancer: a metaanalysis. Neurology. 2004;63:1230-1233. https://doi.org/10.1212/01.wnl.0000140491.54664.50
26. Noonan S, Pasa A, Fontana V, et al. A survey among breast cancer specialists on the low uptake of therapeutic prevention with tamoxifen or raloxifene. Cancer Prev Res (Phila). 2018;11:38-43. https://doi.org/10.1158/1940-6207.capr-17-0162
27. Smith SG, Sestak I, Howell A, et al. Participant-reported symptoms and their effect on long-term adherence in the International Breast Cancer Intervention Study I (IBIS I). J Clin Oncol. 2017;35:2666–2673. https://doi.org/10.1200/jco.2016.71.7439
28. Lazzeroni M, DeCensi A. Alternate dosing schedules for cancer chemopreventive agents. Semin Oncol. 2016;43:116-122. https://doi.org/10.1053/j.seminoncol.2015.09.014
29. Bender CM, Sereika SM, Berga SL, et al. Cognitive impairment associated with adjuvant therapy in breast cancer. Psychooncology. 2006;15:422-430. https://doi.org/10.1002/pon.964
30. Cella D, Fallowfield LJ. Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy. Breast Cancer Res Treat. 2008;107:167-180. https://doi.org/10.1007/s10549-007-9548-1
31. Vial T. French pharmacovigilance: Missions, organization and perspectives. Therapie. 2016;71:143-150. https://doi. org/10.1016/j.therap.2016.02.029
32. Laroche ML, Batz A, Geniaux H, et al. Pharmacovigilance in Europe: Place of the Pharmacovigilance Risk Assessment Committee (PRAC) in organisation and decisional processes. Therapie. 2016;71:161-169. https://doi.org/10.1016/j.therap.2016.02.008
33. Bate A, Lindquist M, Edwards IR. The application of knowledge discovery in databases to post-marketing drug safety: example of the WHO database. Fundam Clin Pharmacol. 2008;22:127-140. https://doi.org/10.1111/j.1472-8206.2007.00552.x

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