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Antipsychotic polypharmacy: a needle in a haystack?
Amaia López de Torre1, Unax Lertxundi, Rafael Hernández
1Pharmacy Service, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao, Basque Country, Spain. amaialopez@redfarma.org
General Hospital Psychiatry
|March 31, 2012
Summary
Antipsychotic polypharmacy (APP) affects nearly half of patients, often with higher doses and insufficient evidence. Prudent APP use requires careful patient selection, monitoring, and consideration of drug interactions.
Area of Science:
- Psychiatry
- Clinical Pharmacy
- Pharmacology
Background:
- Antipsychotic polypharmacy (APP) is common in psychiatric settings.
- Evidence supporting common two-drug combinations is often lacking.
- APP use may be associated with increased dosage and potential risks.
Purpose of the Study:
- To determine the prevalence of APP in a psychiatric hospital.
- To evaluate the evidence supporting the most frequent two-drug antipsychotic combinations.
- To assess factors such as clozapine use, elderly prevalence, high dosage, and drug interactions within APP.
Main Methods:
- Retrospective analysis of clinicodemographic and prescription data.
- Definition of high dosage as >1000 mg chlorpromazine equivalents (CPZeq).
- Statistical comparison of dosage and age between APP and monotherapy groups using t tests and chi-squared tests.
Main Results:
- APP prevalence was 47.1% among 172 patients with antipsychotic prescriptions.
- Elderly patients constituted nearly 24% of those on APP.
- Higher mean CPZeq doses (1162 mg vs. 455 mg) and a greater proportion of high-dose patients (54% vs. 9%) were observed in the APP group (P<.0001).
- Evidence supported only 6 of the 10 most prescribed two-drug combinations.
- Clinically relevant interactions were identified in 12 patients on APP.
Conclusions:
- APP is initiated earlier than recommended by guidelines.
- APP is linked to significantly higher total antipsychotic dosages.
- Future APP practice should prioritize evidence-based choices, patient consent, and vigilant monitoring to mitigate risks.
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