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Editorial: Best Practices in Child Antipsychotic Use Monitoring
1Seattle Children's Hospital, University of Washington, Seattle.
Insights
Antipsychotic prescribing for children has surged, raising concerns about off-label use and side effects. Health systems developed strategies to ensure appropriate medication use in youth.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Pharmacology
- Health Services Research
Background:
- Pediatric antipsychotic use has dramatically increased since the 1990s.
- Significant rise in prescribing rates observed from 1996 to 2004, with continued high usage.
- Concerns include variations in use (e.g., foster care), off-label indications, and cardio-metabolic complications.
Discussion:
- Significant variations in antipsychotic use were observed, with higher rates in foster care.
- A majority of prescriptions were for off-label indications.
- Concerns arose regarding cardio-metabolic complications and high costs, impacting healthcare budgets.
Key Insights:
- Rapid increase in pediatric antipsychotic use necessitates careful monitoring.
- Off-label prescribing and adverse events are critical considerations.
- Health systems developed strategies to ensure appropriate antipsychotic medication use in children.
Outlook:
- Need for evidence-based guidelines for pediatric antipsychotic prescribing.
- Ongoing research into long-term effects and safer alternatives.
- Focus on appropriate use to mitigate risks and optimize patient outcomes.
Abstract:
One major change in our field over the past 20 years has been the rapid increase and acceptance of antipsychotic use for children. Pediatric use of antipsychotics was quite rare as recently as the early 1990s, though this was followed by a roughly 6-fold increase in antipsychotic prescribing from 1996 to 2004 with continued higher use rates.1 There is, of course, nothing inherently wrong with rapidly increasing use of a drug class, particularly when it yields significant clinical results. However, alarm was raised for several reasons, such as use variations (eg, children in foster care having much higher rates of use), a majority of antipsychotic use for off-label indications, and significant cardio/metabolic medical complications from their use.2,3 Cost was another concern before generics were available; for instance, all-ages antipsychotic use at one time accounted for nearly one-third of my state's entire Medicaid pharmacy budget. These factors together drove health systems to devise and implement strategies to ensure that youth receiving antipsychotic medications were receiving them appropriately.
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