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Multiple antipsychotic medication prescribing patterns
Jennifer E Schumacher1, Eugene H Makela, Holly R Griffin
1Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA. jfullen@hsc.wvu.edu
The Annals of Pharmacotherapy
|July 5, 2003
Summary
Clinicians often prescribe multiple antipsychotic medications without adequate documentation or prior monotherapy trials. This practice highlights a need for careful assessment of effectiveness and safety in schizophrenia treatment.
Area of Science:
- Psychiatry and Pharmacology
- Clinical Pharmacy
- Schizophrenia Treatment
Background:
- Concomitant use of multiple antipsychotic medications is a common practice.
- The rationale and effectiveness of this polypharmacy approach require further investigation.
Purpose of the Study:
- To evaluate current prescribing patterns of antipsychotic polypharmacy.
- To identify reasons for prescribing more than one scheduled antipsychotic agent.
- To assess the adequacy of prior monotherapy trials and documentation of rationale.
Main Methods:
- Prospective evaluation of 206 patients receiving antipsychotic therapy over 60 days.
- Inclusion of 85 patients receiving two or more scheduled antipsychotic agents.
- Analysis of patient demographics, medication combinations, treatment history, and prescriber rationale.
Main Results:
- 41% of patients received at least two antipsychotic agents concurrently.
- Augmentation was the most common rationale cited for combination therapy.
- Over half of patients lacked adequate monotherapy trials, and 51% of records lacked documented rationale.
Conclusions:
- The use of multiple antipsychotic agents is an area lacking robust evidence.
- Prescribers must exercise heightened awareness regarding effectiveness and safety.
- Essential elements for optimal care include documenting rationale, adverse effects, and treatment response.
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