Short-term vital sign changes following sedative psychotropic initiation in hospitalized patients: A retrospective cohort study

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Objective: Sedative psychotropic medications, such as olanzapine, quetiapine, mirtazapine, and trazodone, are commonly used in hospitalized patients to manage psychiatric symptoms, such as insomnia, restlessness, and agitation.Despite their widespread use, data on their short-term effects on vital signs in medically complex patients are limited.Understanding these effects is crucial for optimizing patient safety in acute care settings.This retrospective cohort study aimed to assess the effect of olanzapine, quetiapine, mirtazapine, and trazodone on vital signs (systolic and diastolic blood pressure, heart rate, oxygen saturation, and body temperature) in non-intensive care unit hospitalized patients.Method: Among 871 screened consultation episodes, 184 patients met eligibility criteria and were included in the final analysis.Vital signs were collected at six standardized time points, 24 h before and after medication initiation.Linear mixed-effects models with subject-specific random intercepts were used to examine the treatment group, phase (pre-post), time of the day, and group-by-phase interactions.Multiple tests across the five primary phase effects were conducted using the Holm correction.Results: Across all vital sign outcomes, fixed-effect estimates were small and indicated minimal physiological change.Heart rate showed a modest unadjusted decrease from pre-to post-exposure (β =-1.72 beats/min, 95% CI -3.11 to -0.33; p =.017); however, this association did not remain statistically significant after adjustment for multiple comparisons (Holm-adjusted p =.083).No statistically significant phase effects or group-by-phase interaction effects were observed for systolic blood pressure, diastolic blood pressure, or oxygen saturation.Discussion: In this medically complex inpatient cohort, commonly used sedative psychotropic agents (olanzapine, quetiapine, mirtazapine, and trazodone) did not produce clinically meaningful short-term changes in the vital signs.These findings support the cautious but routine use of these agents in inpatients, with standard monitoring.Further prospective studies are recommended to explore the long-term outcomes and potential drug interactions.