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Changes in anticonvulsant prescribing for Australian children: implications for Quality Use of Medicines

Simon A Cohen1, John A Lawson, Linda V Graudins

  • 1Department of Paediatric Neurology, Sydney Children's Hospital, Randwick, Australia. simon.cohen@sesiahs.health.nsw.gov.au

Journal of Paediatrics and Child Health
|November 5, 2011
PubMed

Insights

Australian children show increased use of newer anticonvulsants, with some prescribed off-label. This shift from older epilepsy drugs like carbamazepine warrants further investigation into medication use and outcomes.

Area of Science:

  • Pharmacology and Therapeutics
  • Paediatric Medicine
  • Drug Utilization Studies

Background:

  • Limited evidence guides anticonvulsant selection in children.
  • Inappropriate prescribing risks ineffective or harmful treatments for paediatric patients.
  • Understanding prescribing trends is crucial for optimizing medication use.

Purpose of the Study:

  • To analyze anticonvulsant prescribing patterns in Australian children (aged <16 years).
  • To evaluate trends in the use of both established and newer anticonvulsants.
  • To assess the extent of off-label prescribing for newer anticonvulsant agents.

Main Methods:

  • Utilized aggregated national data on 15 anticonvulsants dispensed via the Pharmaceutical Benefits Scheme (PBS).
  • Analyzed prescribing trends for the five most prescribed anticonvulsants between 2002 and 2009.
  • Examined off-label prescribing based on Australian product information regarding minimum age.

Main Results:

  • Valproate remained the most prescribed anticonvulsant; carbamazepine prescriptions decreased by 38%.
  • Newer agents like lamotrigine showed significant use, with levetiracetam prescriptions increasing steeply post-PBS listing.
  • Off-label prescribing was noted: 3.6% of topiramate for children <2 years and 4.2% of levetiracetam for children <4 years.

Conclusions:

  • A substantial shift towards newer anticonvulsants, including off-label use, was observed.
  • This trend raises concerns regarding the Quality Use of Medicines in paediatric epilepsy management.
  • Further research is essential to understand the clinical and economic implications of these prescribing changes.
Abstract

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