Evidence-based recommendations for monitoring safety of second-generation antipsychotics in children and youth

Pringsheim, Tamara; Panagiotopoulos, Constadina; Davidson, Jana; Ho, Josephine

doi:10.1093/pch/16.9.581

Cited by 149 publications

(146 citation statements)

References 16 publications

(13 reference statements)

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“…6,7,[28][29][30] The extent to which SGAs adversely affect glucose levels independent of druginduced weight gain is unclear. Nevertheless, because studies have revealed worsening glucose control and newonset diabetes during treatment with SGAs including olanzapine and risperidone, 28,31,32 obtaining a baseline glucose level to establish whether glucose control is normal or impaired at the time of initiating SGA therapy is prudent.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Raebel

Penfold

McMahon³

et al. 2014

Pediatrics

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OBJECTIVES: In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs); guidelines have recommended metabolic screening since 2004. However, little is known of contemporary practices of glucose screening among youth initiating SGAs. Our objective was to evaluate baseline glucose assessment among youth in the Mini-Sentinel Distributed Database starting an SGA. METHODS: The cohort included youth ages 2 through 18 newly initiating SGAs January 1, 2006, through December 31, 2011, across 10 sites. Baseline glucose was defined as fasting/random glucose or hemoglobin A1c (GLU) measurement occurring relative to first SGA dispensing. Differences in GLU assessment were evaluated with χ2 tests and logistic regression. RESULTS: The cohort included 16 304 youth; 60% boys; mean age 12.8 years. Risperidone was most commonly started (43%). Eleven percent (n = 1858) had GLU assessed between 90 days before and 3 days after first dispensing. Assessment varied across SGAs (olanzapine highest), sites (integrated health care systems higher), ages (16–18 highest), years (2007 highest), and gender (female higher; all P < .001). GLU assessment among those starting olanzapine was more likely than among those starting quetiapine (odds ratio [OR]: 1.72 [95% confidence interval (CI): 1.37–2.18]), aripiprazole (OR: 1.49 [95% CI: 1.18–1.87]), or risperidone (OR: 1.61 [95% CI: 1.28–2.03]). CONCLUSIONS: Few children and adolescents starting SGA have baseline glucose assessed. This is concerning because those at high diabetes risk may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia development.

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Section: Discussionmentioning

confidence: 99%

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Raebel

Penfold

McMahon³

et al. 2014

Pediatrics

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“…43,44 In addition to concerns over the use of quetiapine in treating patients with major depression, anxiety or sleep problems, we have concerns about inadequate monitoring of patients of all ages who are taking quetiapine and other antipsychotics. 4,45 This issue is most pressing in relation to quetiapine because of its widespread off-label use. 46 We suggest that clinicians adhere to published monitoring guidelines when prescribing …”

Section: Cmaj Openmentioning

confidence: 99%

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

Pringsheim

Gardner

2014

CMAJ Open

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“…Although the use of antipsychotic medications in the pediatric population has increased dramatically over the last decade, limited data are available regarding their safety and efficacy. 2,3 In 2003, the Food and Drug Administration (FDA) issued a warning for second-generation antipsychotic (SGA) drugs regarding an increased risk of hyperglycemia and diabetes and required an update on the product labeling to include information about these events. 4 The following year, the American Diabetes Association (ADA) and the American Psychiatric Association (APA) released a consensus statement, linking the use of SGAs with an increased risk for diabetes, obesity, and dyslipidemia.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Monitoring for Metabolic Effects in Children Treated With Second Generation Antipsychotics in a Pediatric Clinic

Honey

Ramos

Brahm

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVESThe aim of this retrospective study was to identify the frequency of recommended metabolic monitoring and follow-up in pediatric patients on second-generation antipsychotic (SGA) medications from a pediatric clinic. METHODS A retrospective review of electronic medical records of all patients on antipsychotics from an academic medical center pediatric clinic was conducted. Inclusion criteria required patients to be established members of the pediatric clinic, < 19 years of age, and on ≥ 1 SGA for at least 1 year, regardless of medical diagnosis. Data collection consisted of patient demographic information and frequency of family history, vital signs, and recommended laboratory monitoring. RESULTS A total of 67 patients on antipsychotics were identified. After the application of inclusion criteria, 32 patients qualified for review. The average age was 13.5 ± 4 years and gender distribution included 72% males. Only 4 (13%) patients had documented baseline monitoring that included weight, blood pressure, and fasting lipid panel. No patient had a fasting plasma glucose recorded at any point during antipsychotic therapy. Follow-up monitoring decreased over time, with the exception of quarterly weight and annual blood pressure. CONCLUSIONS The results of this study highlight the lack of baseline and periodic monitoring that occur when pediatric patients are prescribed antipsychotic medications, putting the patient at risk for adverse events. The marked increase in antipsychotic prescribing and concerns related to their safety emphasize the need for improvement in monitoring of antipsychotic medications. This gap in patient care and safety opens an excellent opportunity for a clinical pharmacy team to provide education and assistance with SGA monitoring for the purpose of providing optimal patient care.

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Evidence-based recommendations for monitoring safety of second-generation antipsychotics in children and youth

Cited by 149 publications

References 16 publications

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

Evaluation of Monitoring for Metabolic Effects in Children Treated With Second Generation Antipsychotics in a Pediatric Clinic

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