Sedative Antipsychotic Use by Children and Adolescents in The Netherlands: Dosages, Duration, and Prescribers

Increasing dispensing of sedative antipsychotics in children and adolescents has been reported in several countries, including the Netherlands, raising concerns about appropriate prescribing and safety. While previous studies have described antipsychotic use in Dutch youth, detailed information on dispensing patterns, dosages, treatment duration, and prescribers of sedative antipsychotics remains limited. This study therefore examined the dispensing patterns of quetiapine, olanzapine, and pipamperone and compared them with aripiprazole and risperidone, using data from the IADB.nl database.

Data from the IADB.nl pharmacy dispensing database (120 Dutch community pharmacies) were analyzed to assess sedative antipsychotic dispensing patterns in children and adolescents, aged between 0 and 19 from 2017 to 2022. Dispensing rates, dosages, durations, sex differences, and prescriber types were analyzed using descriptive statistics, Kaplan-Meier survival analysis, Wilcoxon signed-rank tests, and Kolmogorov-Smirnov tests.

Dispensing rates increased for quetiapine (0.33 to 0.63/1000) and olanzapine (0.16 to 0.23/1000) from 2017 to 2022, while pipamperone decreased (0.54 to 0.33/1000). Most quetiapine prescriptions (91.5%) were low-dose (<100 mg). Girls received significantly lower doses (43.37 mg) compared with boys (53.25 mg). Median use duration was shortest for quetiapine (3 months) and longest for pipamperone (10 months). General practitioners (GPs) initiated 26% of sedative antipsychotic prescriptions, with quetiapine being the most frequently prescribed, especially by GPs. Specialist-initiated prescriptions generally had longer durations than those initiated by GPs.

Rising quetiapine and olanzapine prescriptions, especially low-dose quetiapine despite known adverse effects, raise safety and efficacy concerns. Increased olanzapine use may reflect broader indications; decreased pipamperone suggests shifting preferences. Sex differences in dosage and treatment duration underscore potential clinical or pharmacological differences. These findings call for safer use through individualized prescribing based on clinical indication, patient characteristics, and clear treatment goals, supported by specialist oversight and structured monitoring, alongside stricter guideline adherence and further research on the long-term impacts of sedative antipsychotics in youth.