Monthly Archives: October 2008

Growing International Concern about the Use of Antipsychotics

Otago Daily Times
Pharmac acts over concerns at high use of antipsychotics
News: National

Concern overseas about the high use of antipsychotic medicines in the elderly has prompted government drug buying agency Pharmac and the College of Psychiatrists to release new usage guidelines here.

Concern has been expressed in the United States and Britain that high usage of antipsychotics in the elderly carries potential health risks including possible increased risk of stroke and higher death rates.

While it was unclear whether there was significant over-prescribing of antipsychotics in New Zealand, Pharmac’s prescribing data showed there was comparatively high use of antipsychotics among older people.

In 2006/07 about 20 percent of older-generation antipsychotics, 24 percent of risperidone [risperdal] and 17 percent of quetiapine [seroquel] prescriptions were for people aged between 80 and 90.

About 35,000 prescriptions were recorded for people aged 80-90.

“When this data is coupled with growing international concern about the use of antipsychotics in the elderly, we think it’s the right time to develop guidance on how best to use these medicines,” Pharmac’s medical director Peter Moodie said.

“This isn’t about telling doctors how to do their jobs, it’s about ensuring these medicines are used well and risks to patients are minimised.”

Dr Moodie said the guidance encouraged evidence-based treatment of elderly people in residential care with psychological and behavioural symptoms of mental disorders.

Dementia was the most common psychiatric disorder in that sector of people.


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Curbs sought on psychiatric drugs given to children

Lexington Herald Leader
Curbs sought on psychiatric drugs given to children
By Jim Warren

Kentucky’s Medicaid program has spent more than $40 million since 2001 filling prescriptions for certain powerful drugs that help youngsters with emotional problems, but also could pose risks for their physical health.

Now, the program’s medical director, Dr. Thomas Badgett, wants to rein in prescriptions for so-called “atypical anti-psychotic” drugs in children. Badgett plans to launch an effort early next year alerting Kentucky Medicaid providers to prescribe the drugs for youngsters only when their use is appropriate and to carefully monitor patients for problems.

Similar efforts in other states have reduced prescriptions of atypical anti-psychotics and saved millions of dollars, officials say.

Atypical anti-psychotics are a relatively new class of drugs often prescribed for conditions in both adults and children such as schizophrenia, bipolar disorder and irritability associated with autism. But mounting evidence suggests that they also can cause dramatic weight gains in some children and put youngsters at increased risk for Type II diabetes.

Badgett said an in-house assessment three years ago showed Kentucky Medicaid was “spending an incredible amount of money” on atypical anti-psychotics, and that many young Medicaid patients were taking four or more of the potent drugs at the same time, often obtaining them from multiple prescribers. According to Badgett, 42,000 Kentucky children under age 18, including children in foster care, were receiving atypical anti-psychotics through Medicaid as recently as 2005. He said numbers have been dropping since then.

According to figures provided by the state, Medicaid has spent more $40 million since 2001 filling prescriptions of just three atypical anti-psychotics — Geodon, Seroquel and Zyprexa — for Kentucky youngsters covered by the medical welfare program. Prescriptions for those drugs were filled more than 25,000 times during the period, the figures show.
Badgett, who is a pediatrician, said he began questioning such drugs when he was in private practice before joining Medicaid in 2004.

“I would have young patients go off to see a behavioral health specialist, and some would come back on these drugs,” he said. “Frequently, they would experience just an incredible weight gain.

“That can be very emotionally upsetting to a young person, even though these drugs are supposed to deal with emotional problems. I got quite concerned about it.”

Some recent studies suggest that atypical anti-psychotics could be no more effective that some older anti-pschyotic medications in treating emotional problems. Physicians and other experts also acknowledge that the atypicals do pose a risk for rapid weight gain in children, with reports of some young patients quickly putting on 30 pounds or more.

But Robert Kuhn, a pharmacy professor at the University of Kentucky, said atypical anti-psychotics do offer a significant advantage: They are less likely to cause young patients to develop movement disorders, such as jerks or tics, than the older drugs are.

“Clearly, there are some children who are going to do better on these drugs than on more traditional medications,” he said.

Kuhn added that regular monitoring of young patients’ weight, glucose levels and other markers should enable doctors to spot early signs of weight gains or other risks and head them off by switching to other drugs or putting patients on exercise programs.

In extreme cases, some weight gain might be a worthwhile trade-off, some practitioners suggest.

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