정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
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불면증 환자의 Doxepin 치료 중단율

Discontinuation Rate of Doxepin in Insomnia Patients

  • 이지현 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 김성민 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 홍승철 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 서호준 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 김태원 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 엄유현 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 정종현 (가톨릭대학교 의과대학 정신건강의학교실)
  • Lee, Ji Hyeon (Department of Psychiatry, College of Medicine, Catholic University of Korea) ;
  • Kim, Sung-Min (Department of Psychiatry, College of Medicine, Catholic University of Korea) ;
  • Hong, Seung-Chul (Department of Psychiatry, College of Medicine, Catholic University of Korea) ;
  • Seo, Ho-Jun (Department of Psychiatry, College of Medicine, Catholic University of Korea) ;
  • Kim, Tae-Won (Department of Psychiatry, College of Medicine, Catholic University of Korea) ;
  • Um, Yoo-Hyun (Department of Psychiatry, College of Medicine, Catholic University of Korea) ;
  • Jeong, Jong-Hyun (Department of Psychiatry, College of Medicine, Catholic University of Korea)
  • 투고 : 2018.04.18
  • 심사 : 2018.06.12
  • 발행 : 2018.06.30
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초록

연구목적 일 대학 병원 정신건강의학과의 불면증 외래 환자에서 doxepin 처방 패턴에 따른 doxepin 치료 중단율 및 중단 이유에 차이가 있는지 확인하고자 하였다. 방 법 불면증 치료를 위해 doxepin을 처방한 외래 환자 534명의 환자를 선별한 후, 전자의무기록을 후향적으로 검토하여 201명의 환자를 대상으로 doxepin 처방 2개월 후 치료 중단율을 조사하였고, doxepin 처방 패턴에 따라 처음으로 수면 목적의 약제로 doxepin을 처방 받은 환자들을 initial군, 기존에 복용하던 수면 목적의 약제를 유지하면서 doxepin을 추가 처방한 경우를 add-on군, 기존에 수면 목적의 약제를 복용하였고 기존 약제를 중단하고 doxepin으로 약물을 변경한 경우를 switching군으로 나누어 doxepin 중단률 및 중단 이유를 조사하고 세 그룹간에 비교하였다. 결 과 2개월 후 doxepin 치료 중단율은 56.2%였고, 세 군 간의 치료 중단율에 유의한 차이가 있었다. Initial군이 세 군 중에 가장 높은 치료 중단율을 보였고, add-on 군이 가장 낮은 치료 중단율을 보였다(p=0.018). 각 군별 doxepin 치료 중단의 이유에서는 효과부족(p<0.001), 이상반응(p<0.001)이 add-on군에서 유의하게 높게 확인되었고, 환자거부(p=0.022), 원인미상 및 추적실패(p<0.001)가 initial군에서 유의하게 높은 결과를 보였다. 결 론 본 연구 결과 실제 임상 진료 상황에서는 add-on 방법이 약물의 switching 방법보다 doxepin 치료 유지에 적합하며, 부작용을 예방하기 위해 기존에 복용하던 수면제 및 수면에 도움을 주는 약제를 단계적으로 줄여야 함을 확인하였다. 추후 대규모 전향적 연구를 통하여 doxepin 치료 중단과 관련된 다양한 변인 및 위험요인들이 체계적으로 평가될 필요가 있다.

Objectives : We aimed to investigate the discontinuation rate and reasons of doxepin base prescription pattern in insomnia outpatients of psychiatry department of a university hospital. Methods : 534 patients prescribed doxepin were screened. 201 patients were included and reviewed for their medical records retrospectively. The discontinuation rate and reasons of doxepin after 2 months of prescription were investigated. Patients were divided into three groups according to the prescription patterns. The initial group, prescribed doxepin as the first hypnotic, the add-on group, prescribed doxepin while maintaining existing hypnotics, and the switching group, prescribed doxepin after discontinuation of existing hypnotics. Results : The discontinuation rate after 2 months of prescription of doxepin was 56.2%. There were significant differences in the discontinuation rate among three groups. The initial group had the highest while the add-on group had the lowest (p=0.018). In reasons for discontinuation of doxepin among three groups, lack of efficacy (p<0.001) and adverse events (p<0.001) were significantly higher in the add-on group. In the initial group, patient's refusal (p=0.022) and unknown or loss to follow up (p<0.001) were significantly higher. Conclusions : The results of this study suggested that add-on is superior than switching method and gradual reduction of existing hypnotics is necessary to maintain doxepin treatment and prevent adverse events. Additional large scale prospective studies are needed to evaluate various factors and risks of discontinuation of doxepin.

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