A retrospective study of antipsychotic drug switching in a pediatric population

Abstract

BackgroundAntipsychotic drugs can be used to help treat a wide variety of psychiatric disorders. However, specific antipsychotic drugs for any particular patient may need to be changed for a number of different reasons, including a lack of therapeutic efficacy and / or intolerance to medication side-effects. Drug switching may occur through a limited number of established patterns. The nature of these changes is not well characterized in youth, despite their frequent occurrence.MethodsA retrospective analysis of antipsychotic drug switches was conducted on patients who had been admitted as inpatients to a tertiary care child and adolescent psychiatric institute. PharmaNet (a large, central administrative database) records of all medications prescribed in the 52 weeks prior to admission, and then between admission and discharge, were analyzed for switching patterns. Additional data regarding diagnoses were obtained from medical chart review.ResultsPatients represented a diagnostically heterogeneous population, and almost all antipsychotic drugs were administered off-label. In the one year prior to and during admission to the hospital, a total of 31 out of 139 patients switched antipsychotic drugs. The frequency of switching increased closer to the time of admission, and the proportional rate of switching was even higher during hospital stay. The most common switch was from risperidone to quetiapine. Our analysis identified three main patterns of drug switching, all occurring with similar frequency: titrated drug switches, abrupt drug switches and concurrent drug administration.ConclusionsThe present study indicates that antipsychotic drug switching in youth may be relatively common, particularly in the year prior to hospitalization. No specific manner of drug switching predominates. This study also demonstrates the feasibility of using large administrative databases to characterise switching patterns in youth.

Predictors of antipsychotics switching among ambulatory patients with schizophrenia in Ethiopia: a multicenter hospital-based cross-sectional study

“…In the present study around 99.7% of switching was done by abrupt discontinuation of the first antipsychotics and starting the other antipsychotics. This finding is higher than a study done in Canada 33% [ 58 ], Netherlands 61% [ 59 ]. The reason why high abrupt switching in our setting might be due to a lack of expertise in choosing the appropriate antipsychotics based on patient-specific factors and pharmacokinetics and dynamics of antipsychotic drugs.…”

A comparison of the metabolic side-effects of the second-generation antipsychotic drugs risperidone and paliperidone in animal models

“…The second generation antipsychotic drug risperidone remains one of the most frequently used antipsychotic drugs worldwide [2,16]. The drug's popularity among prescribers is based on a large body of evidence supporting its clinical efficacy and ease of use, with minimal need for monitoring, while dosing options are suitable for many off-label indications in youth and the elderly [17][18][19][20]. In terms of metabolic liability, the drug remains somewhere in the middle of the class, with fewer and less severe metabolic side-effects than olanzapine and clozapine, but greater than some of the newer second generation drugs, such as asenapine and lurasidone [21][22][23].…”

Network Theory and Switching Behaviors: A User Guide for Analyzing Electronic Records Databases

“…Following previous contributions [12,23], here, we will focus on a specific issue that can answer questions such as, "Given a certain drug, what are the other drugs with which a switch is more likely?". This is an example of switching behavior, which is particularly important within health literature [24][25][26]. Under certain circumstances, a physician may ask a patient to switch medication.…”