A prescription survey of the use of atypical antipsychotics for hospital inpatients in the United Kingdom

Abstract

Object: Available efficacy data for atypical antipsychotics relate almost entirely to the use of atypicals alone. Previous surveys have, however, shown that typical antipsychotics are often co-prescribed alongside atypical drugs. We sought to evaluate prescribing of atypical antipsychotics to inpatients during one week of June 1998.

Method: Requests for information were sent out to 229 UK centres which employed psychiatric pharmacists. From these, 143 (62%) responses were received, providing information on 3685 patients prescribed atypical antipsychotics. Data on patients prescribed an atypical for longer than 6 weeks were used as the primary indicator of prescribing practice.

Results: For all atypicals examined, co-prescription of typical drugs was commonplace. The proportions of patients receiving an atypical as the sole antipsychotic were: clozapine 56.5%, risperidone 27.6%, sertindole 27.1%, olanzapine 18.9%, quetiapine 9.7% and amisulpride 7.1%. Patients prescribed regular typical antipsychotics alongside atypical drugs were significantly more likely to be prescribed regular anticholinergic medication, indicating higher rates of acute extrapyramidal effects in those receiving antipsychotic polypharmacy. Atypical antipsychotics were prescribed alone in a minority of patients.

Conclusions: Whilst there is some support for antipsychotic polypharmacy in certain cases, judging by strict evidence-based criteria the prescribing of atypical antipsychotics in our survey was poor. (Int J Psych Clin Pract 2000; 4:41-46).

Keywords: Antipsychotics Polypharmacy Cost-EFFECTIVENESS Prescribing Anticholinergics.