Drug Utilization Study of Psychotropic Drugs in Outdoor Patients in a Teaching Hospital

Patel

Int J Basic Clin Pharmacol

et al. 2017

Background: In the absence of standard psychiatric prescribing information, physician often use drugs in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian Drug Formulary.Methods: After taking permission from Institutional Ethics Committee (IEC), a prospective study was conducted among 285 patients attending Psychiatry outpatient department for the period of 4 months. Data related to demographic parameters, diagnosis of psychiatry conditions and drugs details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India. Multivariate binary logistic regression model was used to determine the predictors of off- label drug prescribing. The data were statistically analyzed using SPSS version 19 and chi-square test.Results: A total of 285 patients (169 males, 116 females) were included in the study with mean age of 36.54±13.91 years. Most of the patients (n=65, 22.8%) were diagnosed as schizophrenic. Out of 285 patients, 133(46.6%) received at least one off-label drug. A total 841 drugs were prescribed out of which 167(19.85%) were off-label. The drug most frequently prescribed as off-label were trihexiphenidyl HCL 29 (10.2%), clozapine 23 (8.1%) and clonazepam 13 (4.6%).Conclusions: Off label drugs used among psychiatry patients was 19.85%. The most frequently used off-label drugs was trihexiphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Drug utilization study of off-label drug use in outpatient department of psychiatry: a prospective study at a tertiary care teaching hospital

Patel

Int J Basic Clin Pharmacol

et al. 2017

“…The prevalence of psychotic disorder was significantly high in the age group of 20-60 y contributing 87.34% in which 20-40 y and 41-60 y contribute to 55.69% and 31.65% respectively. The prevalence in the 20-40years age group is also reflected in a study by Pradeep Bodke et al [6] and also in many other studies [8]. The Prevalence of schizophrenia and Mental retardation with significant impairment of behaviour is significantly high in males when compared to females in the ratio of 3:2 and 6:1 respectively, while the study says there is no difference in prevalence though the incidence seems to be higher in males [9].…”

Section: Profile Of Study Participantsmentioning

confidence: 53%

An Observational Study of Drug Utilisation Pattern and Pharmacovigilance of Antipsychotics

Balaji

Sekkizhar

Kumar

et al. 2017

Int J Curr Pharm Sci

Objective: Drug Utilization Research (DUR) was defined by the WHO in 1977 as "The marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic implications". The main aim of conducting drug utilisation research is to facilitate rational use of drugs i,e the prescription of a well documented drug together with correct information at an affordable cost. Psychiatric disorders form an important public health priority among which psychotic disorders are the chief contributors to disability-adjusted life years [DALYs] and are associated with high levels of health service utilization and treatment cost. Without the knowledge of how drugs are being prescribed and used it is difficult to initiate a discussion on rational drug use or to suggest measures to improve prescribing patterns. To analyse the drug utilization pattern by using standard parameters. Methods:After getting approval from the institutional human ethics committee and consent from the patients willing to participate in this study, a total of 79 prescriptions containing at least one antipsychotic drug was collected in one year period from patients attending psychiatric OPD. The patients were given a one month follow up and the adverse effects which arise out of therapy are noted and analysed.Results: Out of the 79 participants, 59.49% were males and 40.51% were females. Regarding the morbidity distribution, Schizophrenia contributes to 50.63% and bipolar disorder contributes to 29.11% of diagnosis. Based on the analysis by WHO/INRUD standard guidelines, the average number of drugs and antipsychotic drugs per prescription were 3.32 and 1.38 respectively. The utilisation of antipsychotic drugs assessed by PDD/DDD ratio is equal to one for haloperidol and aripiprazole while it is less than one for other antipsychotic drugs. The adverse effects commonly encountered while treating psychotic cases are sedation, extrapyramidal symptoms, weight gain and anticholinergic side effects like constipation and urinary retention. Conclusion:The age and morbidity distribution of the participants are similar to the outcomes of many studies. The antipsychotic drugs haloperidol and aripiprazole are utilised appropriately while there is under utilisation of other antipsychotics. The volume of use of haloperidol, olanzapine benzodiazepines should be judicious considering their adverse effects.Keywords: Schizophrenia (SCHZ), Bipolar disorder (BPAD), Persistent delusional disorder (PDD), Mental Retardation with significant impairment of behaviour (MR/SIB), International network for rational use of drugs (INRUD).

Int J Basic Clin Pharmacol

“…Without the knowledge of how the drugs are being prescribed, it is difficult to suggest the measures to improve prescribing habits. 5 Retrospective drug utilization review can be used to identify problems in prescribing patterns through the analysis and interpretation of aggregate archival data on drug prescriptions. This process has no immediate effect on patient care but can identify trends and prompt interventions.…”

Section: Introductionmentioning

confidence: 99%

Antipsychotics in schizophrenia: a retrospective study of drug utilization pattern in outpatient department of psychiatry at a tertiary care hospital

Patted

Hema

Nagaraj

2017

Background: Psychiatric disorders are one of the major causes of morbidity and the burden of illness is enormous and remains grossly under represented. Psychotropic drugs have had a remarkable impact in psychiatric practice. Currently a large number of atypical antipsychotics available in the market are endorsed as better options for treating schizophrenia than the typical antipsychotics. The main objective of the study was to find the commonly prescribed antipsychotics in schizophrenia patients in a tertiary care center.Methods: After Institutional Ethics Committee approval, a retrospective cross-sectional drug utilization study of 400 prescriptions was under taken from 1st July 2015 to 30th July 2016 in the outpatient department of psychiatry of a tertiary care hospital. The prescribing pattern of antipsychotics in schizophrenia patients (N=107) was measured.Results: Out of 400 cases in the outpatient department, schizophrenia cases were predominant (N=107 i.e. 27%) out of which 42.1% were females and 57.9% were males. This was followed by mood disorders and neurotic & somatoform disorders. The most common antipsychotic used was olanzapine followed by risperidone. Least commonly used antipsychotic was haloperidol. Most of the patients who received risperidone also received an anticholinergic trihexyphenidyl (91.8%).Conclusions: Olanzapine and risperidone are the most commonly used antipsychotics. Anticholinergics should be used only in selected patients on antipsychotics as tolerance develops to extrapyramidal side effects. Anticholinergics are unnecessary after 3-6 months in all except 10% of patients. Moreover, it has its own side effects and adversely interacts with antipsychotics.