Gender specific prescribing in mental health: the implications for women
In this article we consider how the drug handling differences in women should influence the prescribing of psychotropic medicines. Women are generally under-represented in clinical trials and, due to the lack of gender specific data analysis, most drug dose recommendations are tailored to the physiology of men. Women show reduced gastric acid secretion and a delay in the absorption of drugs from the gastrointestinal tract (GIT); this can reduce bioavailability and delay achieving therapeutic drug plasma levels. Similarly, the volume of distribution (Vd) will also affect the bioavailability of drugs. Women tend to have a greater percentage body fat in comparison to men which increases the Vd of lipophilic drugs, this can cause toxicity through drug accumulation in adipose tissue over time. In addition to the difference in fat content, fat distribution in women favours the lower regions of the body, particularly the hips and thighs; this further influences the administration and accumulation of intramuscular (IM) depots. Gender is one of many factors that affect enzyme activity. In comparison to men, women generally show reduced hepatic enzyme activity which delays drug metabolism. The final stage of drug elimination is also slower in women due to reduced glomerular filtration rate (GFR). The delays in metabolism and elimination can affect therapeutic response and cause more pronounced side effects in women. Some psychotropic medicines also pose teratogenic risks. Caution should be exercised when prescribing teratogenic medicines in women of child bearing potential; the risks and benefits of any treatment should be considered carefully.
Keywords: GENDER; PHARMACOKINETICS; PRESCRIBING; PSYCHOTROPICS; WOMEN
Document Type: Commentary
Publication date: 01 April 2019
This article was made available online on 21 October 2018 as a Fast Track article with title: "Gender specific prescribing in mental health: the implications for women".
- Published twice a year, the Journal of Psychiatric Intensive Care is devoted to issues affecting the care and treatment of people with mental disorders who manifest severely disturbed functioning. The journal is international and multidisciplinary. It provides stimulating papers and articles of interest to those who work in or study psychiatric intensive care, low secure services, acute inpatient wards, challenging behaviour environments, emergency psychiatry, or intensive treatments settings in other parts of the wider mental health system. The Journal of Psychiatric Intensive Care encourages informed debate and exchange of opinion. Its content includes editorials, original research, brief reports, reviews, conference reports, news and notices, but preference is given to original research of a high scientific quality.
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