A retrospective study of antipsychotic drug switching in a pediatric population

BMC Psychiatry

Alasdair M Barr³  Lik Hang N Lee³  Dean Elbe¹  Ric M Procyshyn²  David Linton³ 

[1] British Columbia Mental Health and Addictions Services Research Institute, 938 W 28th Avenue, Vancouver, BC V5Z 4H4, Canada;Department of Psychiatry, University of British Columbia, Vancouver V6T 1Z3, Canada;Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver V6T 1Z3, Canada

关键词: Switching;    Polypharmacy;    Drug;    Children;    Antipsychotic;    Adolescent;   

Others  :  1123945
DOI  :  10.1186/1471-244X-13-248

 received in 2012-12-05, accepted in 2013-10-03,  发布年份 2013

【 摘 要 】

Background

Antipsychotic drugs can be used to help treat a wide variety of psychiatric disorders. However, specific antipsychotic drugs for any particular patient may need to be changed for a number of different reasons, including a lack of therapeutic efficacy and / or intolerance to medication side-effects. Drug switching may occur through a limited number of established patterns. The nature of these changes is not well characterized in youth, despite their frequent occurrence.

Methods

A retrospective analysis of antipsychotic drug switches was conducted on patients who had been admitted as inpatients to a tertiary care child and adolescent psychiatric institute. PharmaNet (a large, central administrative database) records of all medications prescribed in the 52 weeks prior to admission, and then between admission and discharge, were analyzed for switching patterns. Additional data regarding diagnoses were obtained from medical chart review.

Results

Patients represented a diagnostically heterogeneous population, and almost all antipsychotic drugs were administered off-label. In the one year prior to and during admission to the hospital, a total of 31 out of 139 patients switched antipsychotic drugs. The frequency of switching increased closer to the time of admission, and the proportional rate of switching was even higher during hospital stay. The most common switch was from risperidone to quetiapine. Our analysis identified three main patterns of drug switching, all occurring with similar frequency: titrated drug switches, abrupt drug switches and concurrent drug administration.

Conclusions

The present study indicates that antipsychotic drug switching in youth may be relatively common, particularly in the year prior to hospitalization. No specific manner of drug switching predominates. This study also demonstrates the feasibility of using large administrative databases to characterise switching patterns in youth.

【 授权许可】

   
2013 Linton et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Procyshyn RM, Honer WG, Wu TK, Ko RW, McIsaac SA, Young AH, Johnson JL, Barr AM: Persistent antipsychotic polypharmacy and excessive dosing in the community psychiatric treatment setting: a review of medication profiles in 435 Canadian outpatients. J Clin Psychiatry 2010, 71(5):566-573.
• [2]Alessi-Severini S, Biscontri RG, Collins DM, Sareen J, Enns MW: Ten years of antipsychotic prescribing to children: a Canadian population-based study. Can J Psychiatry 2012, 57(1):52-58.
• [3]Verdoux H, Tournier M, Begaud B: Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies. Acta Psychiatr Scand 2010, 121(1):4-10.
• [4]Koelch M, Prestel A, Singer H, Keller F, Fegert JM, Schlack R, Hoelling H, Knopf H: Psychotropic medication in children and adolescents in Germany: prevalence, indications, and psychopathological patterns. J Child Adolesc Psychopharmacol 2009, 19(6):765-770.
• [5]Comer JS, Olfson M, Mojtabai R: National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996–2007. J Am Acad Child Adolesc Psychiatry 2010, 49(10):1001-1010.
• [6]Barr AM, Panenka WJ, Honer WG, Khara S, Procyshyn RM: Excessive antipsychotic dosing in a Canadian outpatient population. Psychiatr Serv 2011, 62(6):682-683.
• [7]Gentile S: Clinical usefulness of second-generation antipsychotics in treating children and adolescents diagnosed with bipolar or schizophrenic disorders. Paediatr Drugs 2011, 13(5):291-302.
• [8]Fraguas D, Correll CU, Merchan-Naranjo J, Rapado-Castro M, Parellada M, Moreno C, Arango C: Efficacy and safety of second-generation antipsychotics in children and adolescents with psychotic and bipolar spectrum disorders: comprehensive review of prospective head-to-head and placebo-controlled comparisons. Eur Neuropsychopharmacol 2011, 21(8):621-645.
• [9]Honer WG, Thornton AE, Sherwood M, MacEwan GW, Ehmann TS, Williams R, Kopala LC, Procyshyn R, Barr AM: Conceptual and methodological issues in the design of clinical trials of antipsychotics for the treatment of schizophrenia. CNS Drugs 2007, 21(9):699-714.
• [10]Maayan L, Correll CU: Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol 2011, 21(6):517-535.
• [11]Seida JC, Schouten JR, Boylan K, Newton AS, Mousavi SS, Beaith A, Vandermeer B, Dryden DM, Carrey N: Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics 2012, 129(3):e771-e784.
• [12]Pringsheim T, Doja A, Belanger S, Patten S: Treatment recommendations for extrapyramidal side effects associated with second-generation antipsychotic use in children and youth. Paediatr Child Health 2011, 16(9):590-598.
• [13]Targum SD, Pestreich L, Reksoprodjo P, Pereira H, Guindon C, Hochfeld M: A global measure to assess switching antipsychotic medications in the treatment of schizophrenia. Hum Psychopharmacol 2012, 27(5):455-463.
• [14]Leung JY, Barr AM, Procyshyn RM, Honer WG, Pang CC: Cardiovascular side-effects of antipsychotic drugs: the role of the autonomic nervous system. Pharmacol Ther 2012, 135(2):113-122.
• [15]Boyda HN, Tse L, Procyshyn RM, Honer WG, Barr AM: Preclinical models of antipsychotic drug-induced metabolic side effects. Trends Pharmacol Sci 2010, 31(10):484-497.
• [16]Boyda HN, Procyshyn RM, Pang CC, Hawkes E, Wong D, Jin CH, Honer WG, Barr AM: Metabolic side-effects of the novel second-generation antipsychotic drugs asenapine and iloperidone: a comparison with olanzapine. PLoS One 2013, 8(1):e53459.
• [17]Boyda HN, Procyshyn RM, Tse L, Hawkes E, Jin CH, Pang CC, Honer WG, Barr AM: Differential effects of 3 classes of antidiabetic drugs on olanzapine-induced glucose dysregulation and insulin resistance in female rats. J Psychiatry Neurosci 2012, 37(6):407-415.
• [18]Boyda HN, Ramos-Miguel A, Procyshyn RM, Topfer E, Lant N, Choy HH, Wong R, Li L, Pang CC, Honer WG, et al.: Routine exercise ameliorates the metabolic side-effects of treatment with the atypical antipsychotic drug olanzapine in rats. Int J Neuropsychopharmacol 2013, 1-14. [Epub ahead of print]
• [19]Stroup TS, McEvoy JP, Ring KD, Hamer RH, LaVange LM, Swartz MS, Rosenheck RA, Perkins DO, Nussbaum AM, Lieberman JA: A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP). Am J Psychiatry 2011, 168(9):947-956.
• [20]Nyhuis AW, Faries DE, Ascher-Svanum H, Stauffer VL, Kinon BJ: Predictors of switching antipsychotic medications in the treatment of schizophrenia. BMC Psychiatry 2010, 10:75. BioMed Central Full Text
• [21]Weiden PJ: Switching antipsychotics: an updated review with a focus on quetiapine. J Psychopharmacol 2006, 20(1):104-118.
• [22]Correll CU: Real-life switching strategies with second-generation antipsychotics. J Clin Psychiatry 2006, 67(1):160-161.
• [23]Masand PS, Berry SL: Switching antipsychotic therapies. Ann Pharmacother 2000, 34(2):200-207.
• [24]Covell NH, Jackson CT, Evans AC, Essock SM: Antipsychotic prescribing practices in Connecticut's public mental health system: rates of changing medications and prescribing styles. Schizophr Bull 2002, 28(1):17-29.
• [25]Su J, Barr AM, Procyshyn RM: Adverse events associated with switching antipsychotics. J Psychiatry Neurosci 2012, 37(1):E1-E2.
• [26]Remington G, Chue P, Stip E, Kopala L, Girard T, Christensen B: The crossover approach to switching antipsychotics: what is the evidence? Schizophr Res 2005, 76(2–3):267-272.
• [27]Loy JH, Merry SN, Hetrick SE, Stasiak K: Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst Rev 2012, 9:CD008559.
• [28]Raymond CB, Morgan SG, Caetano PA: Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence. Psychiatr Serv 2007, 58(1):79-84.
• [29]Buckley PF, Correll CU: Strategies for dosing and switching antipsychotics for optimal clinical management. J Clin Psychiatry 2008, 69(Suppl 1):4-17.
• [30]Lambert TJ: Switching antipsychotic therapy: what to expect and clinical strategies for improving therapeutic outcomes. J Clin Psychiatry 2007, 68(Suppl 6):10-13.
• [31]Virani A, Bezchlibnyk-Butler KZ, Jeffries JJ, Procyshyn RM (Eds): Antipsychotics In Clinical Handbook of Psychotropic Drugs. 19th edition. Toronto, Canada: Hogrefe Publishing; 2012:88-181.
• [32]Barr AM, Procyshyn RM, Hui P, Johnson JL, Honer WG: Self-reported motivation to smoke in schizophrenia is related to antipsychotic drug treatment. Schizophr Res 2008, 100(1–3):252-260.
• [33]Swadi HS, Craig BJ, Pirwani NZ, Black VC, Buchan JC, Bobier CM: A trial of quetiapine compared with risperidone in the treatment of first onset psychosis among 15- to 18-year-old adolescents. Int Clin Psychopharmacol 2010, 25(1):1-6.
• [34]Cohen D, Bonnot O, Bodeau N, Consoli A, Laurent C: Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis. J Clin Psychopharmacol 2012, 32(3):309-316.
• [35]Pringsheim T, Lam D, Ching H, Patten S: Metabolic and neurological complications of second-generation antipsychotic use in children: a systematic review and meta-analysis of randomized controlled trials. Drug Saf 2011, 34(8):651-668.
• [36]Potkin SG, Gharabawi GM, Greenspan AJ, Mahmoud R, Kosik-Gonzalez C, Rupnow MF, Bossie CA, Davidson M, Burtea V, Zhu Y, et al.: A double-blind comparison of risperidone, quetiapine and placebo in patients with schizophrenia experiencing an acute exacerbation requiring hospitalization. Schizophr Res 2006, 85(1–3):254-265.