Neuroleptic drug use in a family-practice center

A three-year retrospective review of neuroleptic drug use at the Family Practice Center of the Medical University of South Carolina was conducted. The charts of 73 patients who had taken neuroleptic agents were reviewed for compliance with the most recent guidelines established by the National Institute of Mental Health (NIMH). Information retrieved included: age, sex, number of clinic visits, diagnosis, neuroleptic agent used, dosages, duration of therapy, concomitant psychotropics, antiparkinson agents, and extrapyramidal side effects. Neuroleptic drug use was considered inappropriate for 26% of the patients' diagnoses. Twenty percent of the dosage regimens were outside the ranges recommended by NIMH. Almost 15% of the medications used consisted of th fixed-combination products of perphenazine and amitriptyline hydrochloride, and 77% of these prescriptions were for dosages below the recommended amounts. Polypsychopharmacy was a common problem, with 36% of the patients receiving one or more psychotropic drugs with a neuroleptic agent. Nineteen patients (26%) had been prescribed an inappropriate psychotropic combination. Nine patients (12%) had received antiparkinson agents. Eight patients (11%) had documented extrapyramidal side effects. Neuroleptic drug use was found to be suboptimal. Various deficiencies were documented particularly in the use of fixed-combination products and because of the problems associated with polypsychopharmacy.