Analysis of Prescribing Patterns of Atypical Antipsychotics in Lhu Caserta

Aims and MethodTo compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.ResultsClassical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).Clinical ImplicationsAlternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.

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Cost Comparison of Atypical Antipsychotics: Paliperidone ER and Risperidone

Hospital Pharmacy ◽

10.1177/0018578718809269 ◽

2018 ◽

Vol 54 (6) ◽

pp. 389-392

Author(s):

Kiranjit Luther ◽

Guang Mei Fung ◽

Farah Khorassani

Keyword(s):

Drug Utilization ◽

Atypical Antipsychotics ◽

Cost Savings ◽

Cost Comparison ◽

Prescribing Patterns ◽

Utilization Review ◽

Drug Utilization Review ◽

Potential Cost ◽

Therapy Cost ◽

The Cost

Purpose: Paliperidone and risperidone are atypical antipsychotics that are structurally and therapeutically similar. Risperidone is metabolized by the liver via cytochrome (CYP) 2D6 to an active metabolite, 9-hydroxyrisperidone. The atypical antipsychotic paliperidone is 9-hydroxyrisperidone formulated separately as an extended-release (ER) tablet and is considerably more expensive than risperidone. The purpose of this retrospective drug utilization review is to evaluate the prescribing patterns of paliperidone ER and evaluate potential cost savings by converting paliperidone ER orders to risperidone at an inpatient psychiatric hospital’s formulary. Methods: This retrospective drug utilization review includes 100 patients, older than 18 years old, who were prescribed oral paliperidone ER at an inpatient, psychiatric hospital between January 1, 2017, and June 2, 2017. The data were collected through the electronic medical records. Patients who were prescribed oral paliperidone ER and refused to take paliperidone ER were excluded from the study population. The cost of each patient’s oral paliperidone ER pharmacotherapy was calculated using average wholesale prices. An equivalent total dose of risperidone therapy was calculated using a 2:3 paliperidone ER to risperidone conversion. The cost savings were then analyzed by comparing the total costs of paliperidone ER with risperidone therapy. Results: The results indicate that from January through June 2017, approximately 68% of all paliperidone ER utilization was for its approved indication of schizophrenia and schizoaffective disorder. The other 32% of utilization was either off-label or for approved indications of risperidone. The total paliperidone ER therapy cost for 100 patients was approximately $17 000, while the cost of risperidone therapy would be approximately $400 for the same patients over 6 months. Overall, this would provide an estimated cost savings of over $33 000 per year or about $169 in savings per patient. Conclusion: The study analysis demonstrates that there are opportunities for cost savings through therapeutic interchange of paliperidone ER to risperidone.

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Tackling myths of common prescribing patterns in schizophrenia amongst Egyptian psychiatrists

Middle East Current Psychiatry ◽

10.1186/s43045-020-00059-4 ◽

2020 ◽

Vol 27 (1) ◽

Author(s):

Samir Abolmagd ◽

Dina Aly El-Gabry ◽

Hussien Elkholy ◽

Karim Abdel Aziz

Keyword(s):

Atypical Antipsychotics ◽

Treatment Guidelines ◽

Mood Stabilizer ◽

Prescribing Patterns ◽

Anticholinergic Medication ◽

Evidence Based ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Related Factors ◽

Antipsychotic Prescribing

Abstract Background There is limited data related to how psychiatrists actually choose amongst different medications, especially in Egypt. Our aim was to survey a sample of psychiatrists regarding common patterns of antipsychotic prescribing practices and review how these vary from the evidence-based. We conducted a qualitative, cross-sectional survey of 124 psychiatrists of different grades from hospitals across Cairo, Egypt. Questions were asked to elicit attitudes towards common antipsychotic prescribing practices and the use of treatment guidelines in schizophrenia. Results A total 77.4% participants said they would prescribe atypical antipsychotics as first-line treatment if cost were not an issue, 42.7% said they commonly add anticholinergics from the start with antipsychotics, 50% said they would maintain patients on anticholinergics for as long as they were receiving antipsychotics, 93.5% said they commonly or in some situations combine typical depot antipsychotics with oral atypical antipsychotics, 88.7% said they commonly or in some situations use antipsychotics in small doses for sedation, and 55.6% sometimes add a mood stabilizer to enhance the effect of antipsychotic drugs. Using logistic regression, physician grade significantly predicted whether participants commonly add anticholinergic medication from the start with antipsychotics (p = 0.001). Age and gender significantly predicted whether participants sometimes add a mood stabilizer to enhance the effect of antipsychotics (p < 0.05). Conclusions We demonstrated that several antipsychotic prescribing practices were not evidence-based, yet appeared to be prevalent in a large proportion of participants. A number of demographic and psychiatrist-related factors predicted certain prescribing patterns.

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Evaluation of Discontinuation of Atypical Antipsychotics Prescribed for ICU Delirium

Journal of Pharmacy Practice ◽

10.1177/0897190012465987 ◽

2012 ◽

Vol 26 (3) ◽

pp. 253-256 ◽

Cited By ~ 31

Author(s):

Karalea D. Jasiak ◽

Ellen A. Middleton ◽

James M. Camamo ◽

Brian L. Erstad ◽

Linda S. Snyder ◽

...

Keyword(s):

Health Care ◽

Adverse Effects ◽

Hospital Discharge ◽

Health Care Costs ◽

Atypical Antipsychotics ◽

Prescribing Patterns ◽

Short Term ◽

Icu Delirium ◽

Care Costs

A number of trials suggest that short-term use of atypical antipsychotics may be useful in the treatment of delirium associated with critical illness. However, long-term use of such agents for this indication has not been studied and may be associated with risks of adverse effects as well as unnecessary health care costs. A retrospective study of prescribing patterns of atypical antipsychotics initiated for the treatment of intensive care unit (ICU) delirium was performed to identify whether these agents were being discontinued prior to or upon hospital discharge. Of the 59 patients who met inclusion criteria and survived to hospital discharge, 28 (47%) were continued on the atypical antipsychotic upon discharge from the medical ICU. For those continued on the agent, 20 patients (71.4%) were prescribed continued therapy as an outpatient. Inpatient costs for atypical antipsychotics during the 9-month study period were increased by approximately $888. Annual cost of the medication as outpatient therapy is assessed at approximately $45 107. Although short-term trials of atypical antipsychotics may be useful for ICU delirium, caution is advised regarding potential adverse effects and added health care costs when use is prolonged.

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Off-label prescribing by psychiatrists

Psychiatric Bulletin ◽

10.1192/pb.30.2.55 ◽

2006 ◽

Vol 30 (2) ◽

pp. 55-57 ◽

Cited By ~ 15

Author(s):

Richard Hodgson ◽

Ravindra Belgamwar

Keyword(s):

One Health ◽

Atypical Antipsychotics ◽

Clinical Excellence ◽

Prescribing Patterns ◽

Best Interests ◽

Off Label Use ◽

Economic Implications ◽

Off Label ◽

Icd 10 ◽

Label Use

Aims and MethodTo report on the use of atypical antipsychotics in one health district by examining secondary care prescribing patterns for these medicines in North Staffordshire between 1994 and 2001. With one exception, these drugs were licensed solely for use in schizophrenia during the study period.ResultsA total of 502 patients were initiated on atypical antipsychotics in the study period. Of these, 297 (59.2%) had a diagnosis of schizophrenia (ICD–10 codes F20–29). Off-label prescribing was common, but psychiatrists were least likely to prescribe clozapine off-label (2.2%). Affective (18.4%) and organic disorders (12.4%) were the main disorders treated off-label. Olanzapine had the highest off-label use (44.5%).Clinical ImplicationsThe high off-label use of atypical antipsychotics has clinical and economic implications. Although off-label prescribing may be in the patient's best interests, they should be informed and give their consent. Commissioning bodies, such as primary care organisations, are basing their budgets on guidance from the National Institute for Clinical Excellence, which can have implications for funding this off-label use.

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