Caffeine Sodium Benzoate for Electroconvulsive Therapy Augmentation. J ECT 2018 Dec;34(4):233-239
Date
05/17/2018Pubmed ID
29768288DOI
10.1097/YCT.0000000000000503Scopus ID
2-s2.0-85056573479 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
OBJECTIVES: Because of an ongoing manufacturer shortage of injectable caffeine sodium benzoate (CSB), patients at our health system were given CSB compounded in-house to increase seizure response during electroconvulsive therapy (ECT). Therefore, we aimed to evaluate its effectiveness and safety as an ECT augmentation agent.
METHODS: Medical records of patients who received compounded CSB at Virginia Commonwealth University Health System were reviewed to identify adults receiving it as part of an index ECT treatment course between June 2012 and December 2016. The primary outcome was change in electroencephalogram seizure duration from pre-caffeine session to initial caffeine session. Data were also collected on demographics, motor seizure duration, maximum heart rate, mean arterial pressure, and concurrent medication use for these sessions and the last caffeine session.
RESULTS: Seven-one patients were included in the study, predominantly white females with a mean age of 58.6 years. The most common indication for ECT was major depressive disorder resistant to pharmacotherapy (71.8%), followed by catatonia associated with another mental disorder (19.7%). Electroencephalogram seizure duration increased by 24.1 seconds on average with first CSB use (P < 0.0001), allowing 24 more patients overall to achieve goal of at least 30 seconds (P < 0.0001). No clinically significant changes in maximum heart rate or mean arterial pressure were observed, nor did any patients require an abortive agent for prolonged seizure. Five patients (7%) discontinued CSB prematurely: 4 related to adverse effects and 1 secondary to ineffectiveness.
CONCLUSIONS: We confirm results of prior studies of the utility of CSB and add that compounded CSB is effective for ECT augmentation, maintaining effectiveness throughout the index course with minimal safety concerns.
Author List
Bozymski KM, Potter TG, Venkatachalam V, Pandurangi AK, Crouse ELAuthor
Kevin M. Bozymski PharmD Assistant Professor in the School of Pharmacy Administration department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Arterial Pressure
Benzoates
Caffeine
Central Nervous System Stimulants
Combined Modality Therapy
Depressive Disorder, Treatment-Resistant
Drug Combinations
Electroconvulsive Therapy
Electroencephalography
Female
Heart Rate
Humans
Male
Middle Aged
Seizures
Treatment Outcome
