Off-Label Prescribing of Antipsychotics in a Danish Child and Adolescent Mental Health Center

Korno, Kristine Tofting; Aagaard, Lise

doi:10.4103/jrpp.jrpp_18_42

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Similar to our results, a recent Dutch register study reported that the incidence on antipsychotic use in girls exceeded that in boys in 2015 (7). Our finding of the rapid increase in the incidence of antipsychotic use in girls may be a result of multiple short treatment periods or antipsychotics being prescribed to girls to treat symptoms or mental disorders such as insomnia, anxiety disorders, mood disorders, and agitation (3,19,20,24,33). Additionally, previous studies have shown that in all age groups boys are treated with antipsychotics for longer periods than girls (7).…”

Section: Discussionsupporting

confidence: 90%

“…In children and adolescents, antipsychotic drugs are frequently used off-label (17,18). In subjects under 18 years of age, 69% to 92% of the antipsychotics are prescribed without official indications (3,19,20). In the US and Europe, the three most commonly prescribed SGAs are in descending order risperidone, quetiapine, and aripiprazole (6,16,21).…”

Section: Introductionmentioning

confidence: 99%

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New Users of Antipsychotics Among Children and Adolescents in 2008–2017: A Nationwide Register Study

et al. 2020

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Introduction: Recently, prescribing antipsychotics for children and adolescents has been increasing in many countries. These drugs are often prescribed off-label, although antipsychotics have been associated with adverse effects. We determined the recent incidence of antipsychotic use among children and adolescents in Finland. Methods: Finnish National Prescription Register including all Finnish inhabitants receiving reimbursement for pharmaceuticals was searched for subjects of 1 to 17 years of age who had started an antipsychotic drug between

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

New Users of Antipsychotics Among Children and Adolescents in 2008–2017: A Nationwide Register Study

et al. 2020

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“…[8], в США до 66% случаев применения антипсихотиков у детей не соответствуют показаниям согласно позиции Управления по санитарному надзору за качеством пищевых продуктов и медикаментов (Food and Drug Administration, FDA). Аналогичная проблема назначения антипсихотиков «вне показаний» среди детей существует в странах Европы: доля таких случаев достигает 92%, большинство назначений приходится на кветиапин и оланзапин [13,14]. Также в исследовании K. Korno и соавт.…”

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“…Также в исследовании K. Korno и соавт. [13] затронут важный аспект -применение антипсихотиков «вне показаний» по возрасту пациента, составляющее 63%.…”

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“…Многие антипсихотики FDA [8] не рекомендует к применению до 18 лет, и это актуально для большинства стран мира [13]. Тем не менее их назначение «вне показаний» у детей и подростков достаточно распространено [13,15]. В России, согласно Государственному реестру лекарственных средств [16], до 18 лет могут использоваться лишь некоторые АВГ и почти все АПГ, хотя есть ограничения для детей младше 15 лет (табл.…”

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Off-label antipsychotics prescription to adolescents with acute psychotic episodes does not cause adverse drug reactions

Ivashchenko

Buromskaya

Malakhova

et al. 2021

RJTAO

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Antipsychotics are often used to treat children and adolescents. Because of their age, there are a lot of off-label prescribed antipsychotics in that population. However, the off-label use of medications is considered to be potentially unsafe.Objective: to evaluate whether the off-label prescription of antipsychotics outside of the approved age group increased the risk of adverse drug reactions in adolescents experiencing an acute psychotic episode.Patients and methods. We analyzed 450 charts of adolescents hospitalized due to an acute psychotic episode (only completed cases). In addition, we evaluated adverse drug reactions adjusted by off-label antipsychotics prescription outside the approved age group using the Global Trigger Tool (GTT). We also registered prescriptions with duplicates drug classes and potentially dangerous drug interactions.Results and discussion. Off-label antipsychotics prescription outside the approved age group was less frequently associated with adverse drug reactions (3.2% vs. 10.5%; p=0.013). The logistic regression analysis did not show any significant associations between the off-label antipsychotic use and increased risk of adverse drug reactions (Odds ratio=0.994 (95% confidence interval 0.572-1.726), p=0.982). Although, patients with off-label use of antipsychotics were more likely to have potentially dangerous drug interactions (35.2% vs. 16.15%; p=0.0001) and prescriptions with duplicates drug classes (39.6% vs. 15.43%; p=0.0001).Conclusion. Off-label antipsychotic prescription outside the approved age group in adolescents with acute psychotic episode does not increase the risk of adverse drug reactions. However, an increase in potentially dangerous drug interactions and prescriptions with duplicates drug classes frequency could be considered red flags. Therefore, we have concluded that the concerns about off-label antipsychotics prescription outside of approved age groups in adolescents with acute psychotic episodes were overrated.

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Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

et al. 2020

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Mental disorders frequently begin in childhood or adolescence. Psychotropic medications have various indications for the treatment of mental disorders in this age group and are used not infrequently off‐label. However, the adverse effects of these medications require special attention during developmentally sensitive periods of life. For this meta‐review, we systematically searched network meta‐analyses and meta‐analyses of randomized controlled trials (RCTs), individual RCTs, and cohort studies reporting on 78 a priori selected adverse events across 19 categories of 80 psychotropic medications – including antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity disorder (ADHD) medications and mood stabilizers – in children and adolescents with mental disorders. We included data from nine network meta‐analyses, 39 meta‐analyses, 90 individual RCTs, and eight cohort studies, including 337,686 children and adolescents. Data on ≥20% of the 78 adverse events were available for six antidepressants (sertraline, escitalopram, paroxetine, fluoxetine, venlafaxine and vilazodone), eight antipsychotics (risperidone, quetiapine, aripiprazole, lurasidone, paliperidone, ziprasidone, olanzapine and asenapine), three anti‐ADHD medications (methylphenidate, atomoxetine and guanfacine), and two mood stabilizers (valproate and lithium). Among these medications with data on ≥20% of the 78 adverse events, a safer profile emerged for escitalopram and fluoxetine among antidepressants, lurasidone for antipsychotics, methylphenidate among anti‐ADHD medications, and lithium among mood stabilizers. The available literature raised most concerns about the safety of venlafaxine, olanzapine, atomoxetine, guanfacine and valproate. Nausea/vomiting and discontinuation due to adverse event were most frequently associated with antidepressants; sedation, extrapyramidal side effects, and weight gain with antipsychotics; anorexia and insomnia with anti‐ADHD medications; sedation and weight gain with mood stabilizers. The results of this comprehensive and updated quantitative systematic meta‐review of top‐tier evidence regarding the safety of antidepressants, antipsychotics, anti‐ADHD medications and mood stabilizers in children and adolescents can inform clinical practice, research and treatment guidelines.

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Off-Label Prescribing of Antipsychotics in a Danish Child and Adolescent Mental Health Center

Cited by 10 publications

References 23 publications

New Users of Antipsychotics Among Children and Adolescents in 2008–2017: A Nationwide Register Study

New Users of Antipsychotics Among Children and Adolescents in 2008–2017: A Nationwide Register Study

Off-label antipsychotics prescription to adolescents with acute psychotic episodes does not cause adverse drug reactions

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

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