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About me

I was born in 1973 and educated at the University of Gothenburg taking my doctors exam in 2002. I then performed my specialization at Södersjukhuset, qualifying as a specialist in Internal Medicine in 2007 and as a specialist in Endocrinology and Diabetes in 2010. Since my specialization I have continued working at Södersjukhuset and been a consultant since 2016.

I defended my thesis at Karolinska Institutet in 2009 becoming an Associate Professor in 2016. Since 2018 I’m part time employed as the Director of Doctoral Education of the Department of Clinical Science and Education at Karolinska Institutet.

Research description

In 2009 I defended my thesis ”Drug-related problems with special emphasis on drug-drug interactions”. The thesis includes pharmacogenetic, pharmacokinetic as well as epidemiologic aspects on mainly adverse effects due to the treatment with psychotropic drugs. Since then I have moved towards a mainly register based research. Several projects have included the use of the Swedish Prescribed Drug Register (SPDR) and investigated prescription patterns but also associations with clinical outcome. 

Combining the SPDR with Auricula and Journalia, registries containing data on individuals  treated with anticoagulantia we have established a cohort of over 100 000 patients treated with warfarin. The cohort enables a unique epidemiologic therapeutic drug monitoring approach, efficiently targeting the effects of any added drug with regard to changes in INR and warfarin doses. So far, we have published data on the effects of initiating carbamazepine and amiodarone. Four of five warfarin-treated patients in whom cotreatment with carbamazepine was initiated experienced subtherapeutic anticoagulative effect within 3–5 weeks. The warfarin dose was subsequently increased by 49 %. For amiodarone, a powerful inhibitor of enzymes of importance for warfarin metabolism, the opposite effect was evident with supratherapeutic  INR and a subsequent average 25 % compensatory dose decrease.  This knowledge is important to avoid severe bleedings or thromboembolic complications due to changes in anticoagulation caused by interactions. Onwards we plan to investigate the effect of several additional drugs.

Another project focuses on different aspects of hyponatremia. We recently established a cohort of over 14 000 individuals hospitalized due to hyponatremia. Using a case control design we studied the associations between antidepressants and hospitalization due to hyponatremia. The results indicated a strong association between selective serotonin reuptake inhibitors (SSRIs) and venlafaxine, and hospitalization due to hyponatremia exclusively related to newly initiated treatment. Consequently, in patients with clinically significant hyponatremia with newly initiated treatment with SSRI or venlafaxine, an alternative treatment should be considered. For patients with ongoing antidepressant treatment, other causes should be explored. The project has a lot of potential. One future aim is to investigate the effects of other drugs. Another is to follow the cohort over time which will be interesting in several ways. For example we plan to compare the cases and controls with regard to mortality.

Publications

Differences in Associations of Antidepressants and Hospitalization Due to Hyponatremia
Farmand S, Lindh Jd, Calissendorff J, Skov J, Falhammar H, Nathanson D, et al
The American journal of medicine 2018;131(1):56-63

The effect of amiodarone on warfarin anticoagulation: a register-based nationwide cohort study involving the Swedish population
Holm J, Lindh Jd, Andersson Ml, Mannheimer B
Journal of thrombosis and haemostasis : JTH 2017;15(3):446-453

No Effect of High-Dose Vitamin D Treatment on β-Cell Function, Insulin Sensitivity, or Glucose Homeostasis in Subjects With Abnormal Glucose Tolerance: A Randomized Clinical Trial
Wagner H, Alvarsson M, Mannheimer B, Degerblad M, Östenson Cg
Diabetes care 2016;39(3):345-52

Risperidone and Venlafaxine Metabolic Ratios Strongly Predict a CYP2D6 Poor Metabolizing Genotype
Mannheimer B, Haslemo T, Lindh Jd, Eliasson E, Molden E
Therapeutic drug monitoring 2016;38(1):127-34

The effect of carbamazepine on warfarin anticoagulation: a register-based nationwide cohort study involving the Swedish population
Mannheimer B, Andersson Ml, Järnbert-pettersson H, Lindh Jd
Journal of thrombosis and haemostasis : JTH 2016;14(4):765-71

[Few drugs dominate among clinically important interactions. Swedish register study lists problem drugs]
Holm J, Eiermann B, Eliasson E, Mannheimer B
Lakartidningen 2015;112():-

Limited value of long-term biochemical follow-up in patients with adrenal incidentalomas-a retrospective cohort study
Yeomans H, Calissendorff J, Volpe C, Falhammar H, Mannheimer B
BMC endocrine disorders 2015;15():6-

No impact of vitamin D on the CYP3A biomarker 4β-hydroxycholesterol in patients with abnormal glucose regulation
Mannheimer B, Wagner H, Östenson Cg, Diczfalusy U
PloS one 2015;10(4):e0121984-

[Vitamin D intoxication caused by drugs bought online. Sky high daily dosage for six months resulted in severe hypercalcemia]
Mannheimer B, Törring O, Nathanson D
Lakartidningen 2015;112():-

Adherence to guidelines for avoiding drug interactions associated with warfarin--a Nationwide Swedish Register Study
Lindh Jd, Andersson Ml, Mannheimer B
PloS one 2014;9(5):e97388-

A limited number of prescribed drugs account for the great majority of drug-drug interactions
Holm J, Eiermann B, Eliasson E, Mannheimer B
European journal of clinical pharmacology 2014;70(11):1375-83

Risperidone metabolic ratio as a biomarker of individual CYP2D6 genotype in schizophrenic patients
Mannheimer B, Holm J, Koukel L, Bertilsson L, Osby U, Eliasson E
European journal of clinical pharmacology 2014;70(6):695-9

[Acute adrenal insufficiency. Easy to miss Waterhouse-Friderichsen syndrome, as shown in two cases]
Wijesekara N, Falhammar H, Rzewuski M, Volpe C, Calissendorff J, Mannheimer B
Lakartidningen 2013;110(41):1807-8

Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study
Settergren J, Eiermann B, Mannheimer B
PloS one 2013;8(8):e69545-

The impact of interacting drugs on dispensed doses of warfarin in the Swedish population: A novel use of population based drug registers
Andersson Ml, Lindh Jd, Mannheimer B
Journal of clinical pharmacology 2013;53(12):1322-7

UGT1A4*3 Encodes Significantly Increased Glucuronidation of Olanzapine in Patients on Maintenance Treatment and in Recombinant Systems
Haslemo T, Loryan I, Ueda N, Mannheimer B, Bertilsson L, Ingelman-sundberg M, et al
CLINICAL PHARMACOLOGY & THERAPEUTICS 2012;92(2):221-7

Carriers of the UGT1A4 142T > G gene variant are predisposed to reduced olanzapine exposure-an impact similar to male gender or smoking in schizophrenic patients
Ghotbi R, Mannheimer B, Aklillu E, Suda A, Bertilsson L, Eliasson E, et al
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 2010;66(5):465-74

Drug-drug interactions that reduce the formation of pharmacologically active metabolites: a poorly understood problem in clinical practice
Mannheimer B, Eliasson E
JOURNAL OF INTERNAL MEDICINE 2010;268(6):540-8

Nationwide drug-dispensing data reveal important differences in adherence to drug label recommendations on CYP2D6-dependent drug interactions
Mannheimer B, Wettermark B, Lundberg M, Pettersson H, Von Bahr C, Eliasson E
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY 2010;69(4):411-7

["Silent" interactions are often missed. Different combinations of pharmaceuticals can result in non-drug effect]
Mannheimer B, Eliasson E
Lakartidningen 2010;107(22):1459-

How Drug-Drug Interactions Related to Serotonin Reuptake Inhibitors Affect Drug Dispensing: A Population-Based Study
Mannheimer B, Wettermark B, Lundberg M, Pettersson H, Von Bahr C, Eliasson E
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 2009;:S242-S242

HOW DRUG-DRUG INTERACTIONS RELATED TO SEROTONIN REUPTAKE INHIBITORS AFFECT DRUG DISPENSING: A POPULATION-BASED STUDY
Mannheimer B, Wettermark B, Lundberg M, Pettersson H, Von Bahr C, Eliasson E
BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY 2009;:68-69

A clinical evaluation of the Janus Web Application, a software screening tool for drug-drug interactions
Mannheimer B, Ulfvarson J, Eklof S, Bergqvist M, Von Bahr C
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 2008;64(12):1209-14

Impact of multiple inhibitors or substrates of cytochrome P450 2D6 on plasma risperidone levels in patients on polypharmacy
Mannheimer B, Von Bahr C, Pettersson H, Eliasson E
THERAPEUTIC DRUG MONITORING 2008;30(5):565-9

[Right-sided hydrothorax--the only sign of ovarian hyperstimulation syndrome]
Mannheimer B, Wramsby M
Lakartidningen 2007;104(3):132-3

The validation of a new quality of life questionnaire for patients with congestive heart failure - an extension of the Cardiac Health Profile
Mannheimer B, Andersson B, Carlsson L, Wahrborg P
SCANDINAVIAN CARDIOVASCULAR JOURNAL 2007;41(4):235-41

An evaluation of the Janus Web Application: A computer program used for screening for drug-drug interactions
Mannheimer B, Ulfvarson J, Eklof S, Bergqvist M, Von Bahr C
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 2006;15(4):287-288

Descriptive study and pharmacoterapeutic advisory intervention at a medicine clinic of a large hospital in Stockholm
Mannheimer B, Ulfvarson J, Bergqvist M, Von Bahr C
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 2006;:S154-S154

Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic
Mannheimer B, Ulfvarson J, Eklof S, Bergqvist M, Andersen-karlsson E, Pettersson H, et al
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 2006;62(12):1075-81

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