The results of our study should be considered in view of some limitations. First of all, we used outpatient prescription/dispensation data and had no information about actual use of the medications. Second, the study was performed using computerized medical records from 7 healthcare databases thus limiting the generalizability of the results, since some categories of patients, such as inpatients or elderly persons with mental illnesses residing in nursing homes, were missing. Furthermore, the very low prescription rate of atypical APDs observed in ERD may be explained by the fact that in Italy these drugs are partially dispensed through direct distribution from local psychiatric services and cannot be captured in the outpatient pharmaceutical dispensing flow which was considered in this study. As a consequence, an underestimation of the use of atypical APDs may have been occurred in this database. Nevertheless, because GPs in Italy initiate APD treatment for some patients and continue treatments begun by specialists for other patients, data from HSD are likely to be more representative of national trends than those from ERD, especially for atypical APDs. Conclusions In conclusion, a large use of APDs with torsadogenic liability was reported in the last years in the 5 European countries, despite increasing concerns about their arrhythmogenic potential. The safety warnings issued by regulatory agencies contributed to reduce the use of thioridazine in UK and haloperidol in Italy. The wide use of these medications in elderly patients should be carefully taken into account, given the higher risk of VAs potentially leading to SCD of this population.
The results of our study should be considered in view of some limitations. First of all, we used outpatient prescription/dispensation data and had no information about actual use of the medications. Second, the study was performed using computerized medical records from 7 healthcare databases thus limiting the generalizability of the results, since some categories of patients, such as inpatients or elderly persons with mental illnesses residing in nursing homes, were missing. Furthermore, the very low prescription rate of atypical APDs observed in ERD may be explained by the fact that in Italy these drugs are partially dispensed through direct distribution from local psychiatric services and cannot be captured in the outpatient pharmaceutical dispensing flow which was considered in this study. As a consequence, an underestimation of the use of atypical APDs may have been occurred in this database. Nevertheless, because GPs in Italy initiate APD treatment for some patients and continue treatments begun by specialists for other patients, data from HSD are likely to be more representative of national trends than those from ERD, especially for atypical APDs. Conclusions In conclusion, a large use of APDs with torsadogenic liability was reported in the last years in the 5 European countries, despite increasing concerns about their arrhythmogenic potential. The safety warnings issued by regulatory agencies contributed to reduce the use of thioridazine in UK and haloperidol in Italy. The wide use of these medications in elderly patients should be carefully taken into account, given the higher risk of VAs potentially leading to SCD of this population.