Off-Label Prescribing of Antipsychotics in Adults, Children and Elderly Individuals: A Systematic Review of Recent Prescription Trends

Carton, Louise; Cottencin, Olivier; Lapeyre‐Mestre, Maryse; Geoffroy, Pierre Alexis; Favre, Jonathan; Simon, Nicolas; Bordet, Régis; Rolland, Benjamin

doi:10.2174/1381612821666150619092903

Cited by 162 publications

(157 citation statements)

References 95 publications

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“…Although our sample was also resistant to the treatment with benzodiazepines, the absence of clinical response could be related with the low initial dose of benzodiazepines. As already demonstrated for other antipsychotics [8], asenapine has shown to be ineffective in reducing the drug craving in all subgroups. This data is in line with the currently available information correlating the Reward Deficiency Syndrome and the low D2 receptor density [9].…”

Section: Resultssupporting

confidence: 63%

A Single Dose of Asenapine for the Treatment of Bipolar Patients Affected by Withdrawal Syndrome Induced Psychomotor Agitation: A Pilot, Open-Label Study

Coppola¹,

Mondola²

2017

J Reward Defic Syndr Addict Sci

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Psychomotor agitation is a medical condition associated with a wide range of psychiatric and non psychiatric diseases including: mood disorders, schizophrenia, personality disorders and drug dependence. In our pilot, open-label study, we evaluated the effect of a single dose of sublingual asenapine in bipolar patients affected by withdrawal syndrome induced psychomotor agitation resistant to the treatment with agonist medicines (methadone, gamma hydroxybutyrate and benzodiazepines).

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Section: Resultssupporting

confidence: 63%

A Single Dose of Asenapine for the Treatment of Bipolar Patients Affected by Withdrawal Syndrome Induced Psychomotor Agitation: A Pilot, Open-Label Study

Coppola¹,

Mondola²

2017

J Reward Defic Syndr Addict Sci

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“…17 Up to 75% of antipsychotic use in children and adolescents is estimated to be for off-label indications and there is evidence of low adherence to recommendations for safety monitoring. 18,19 Quality reporting measures and revisions to payment policies have reduced unnecessary use of antipsychotic prescriptions among older adults (aged ≥65 years). 20 Improving safe use of antipsychotics in children and adolescents may require similar strategies.…”

Section: Discussionmentioning

confidence: 99%

US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014

Shehab

Lovegrove

Geller

et al. 2016

JAMA

543

424

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IMPORTANCE The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts. OBJECTIVE To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006. DESIGN, SETTING, AND PARTICIPANTS Active, nationally representative, public health surveillance in 58 EDs located in the United States and participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. EXPOSURES Drugs implicated in ED visits. MAIN OUTCOMES AND MEASURES National weighted estimates of ED visits and subsequent hospitalizations for adverse drug events. RESULTS Based on data from 42 585 cases, an estimated 4.0 (95% CI, 3.1-5.0) ED visits for adverse drug events occurred per 1000 individuals annually in 2013 and 2014 and 27.3% (95% CI, 22.2%-32.4%) of ED visits for adverse drug events resulted in hospitalization. An estimated 34.5% (95% CI, 30.3%-38.8%) of ED visits for adverse drug events occurred among adults aged 65 years or older in 2013-2014 compared with an estimated 25.6% (95% CI, 21.1%-30.0%) in 2005-2006; older adults experienced the highest hospitalization rates (43.6%; 95% CI, 36.6%-50.5%). Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 46.9% (95% CI, 44.2%-49.7%) of ED visits for adverse drug events, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate to severe allergic reactions (antibiotics), and hypoglycemia with moderate to severe neurological effects (diabetes agents). Since 2005-2006, the proportions of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased. Among children aged 5 years or younger, antibiotics were the most common drug class implicated (56.4%; 95% CI, 51.8-61.0%). Among children and adolescents aged 6 to 19 years, antibiotics also were the most common drug class implicated (31.8%; 95% CI, 28.7%-34.9%) in ED visits for adverse drug events, followed by antipsychotics (4.5%; 95% CI, 3.3-5.6%). Among older adults (aged ≥65 years), 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics) were implicated in an estimated 59.9% (95% CI, 56.8%-62.9%) of ED visits for adverse drug events; 4 anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and 5 diabetes agents (insulin and 4 oral agents) were among the 15 most common drugs implicated. Medications to always avoid in older adults according to Beers criteria were implicated in 1.8% (95% CI, 1.5%-2.1%) of ED visits for adverse drug events. CONCLUSIONS AND RELEVANCE The prevalence of emergency department visits for adverse drug events in the United States was estimated to be 4 per 1000 individuals in 2013 an...

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“…Risperidone is the only antipsychotic officially indicated for the treatment of behavioral symptoms of dementia caused by AD . Quetiapine is the most frequently prescribed off‐label antipsychotic among adults, often for treating insomnia . Although the IPT weighting accounts for measured confounders, it is possible that there is residual confounding by indication that can partially explain the results.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer's disease

Tapiainen

Lavikainen

Koponen

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer's disease (AD). DESIGN Nationwide register‐based cohort study. SETTING Medication Use and Alzheimer's Disease (MEDALZ) cohort, Finland. PARTICIPANTS The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded. MEASUREMENTS Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD‐10] codes S00‐S09) and traumatic brain injuries (TBIs; ICD‐10 codes S06.0‐S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks. RESULTS Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person‐years = 1.65 [95% confidence interval {CI} = 1.50‐1.81] for users and 1.26 [95% CI = 1.16‐1.37] for nonusers; IPT‐weighted hazard ratio [HR] = 1.29 [95% CI = 1.14‐1.47]) and TBIs (event rate per 100 person‐years = 0.90 [95% CI = 0.79‐1.02] for users and 0.72 [95% CI = 0.65‐0.81] for nonusers; IPT‐weighted HR = 1.22 [95% CI = 1.03‐1.45]). Quetiapine users had higher risk of TBIs (IPT‐weighted HR = 1.60 [95% CI = 1.15‐2.22]) in comparison to risperidone users. CONCLUSIONS These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies. J Am Geriatr Soc 68:595–602, 2020

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Off-Label Prescribing of Antipsychotics in Adults, Children and Elderly Individuals: A Systematic Review of Recent Prescription Trends

Cited by 162 publications

References 95 publications

A Single Dose of Asenapine for the Treatment of Bipolar Patients Affected by Withdrawal Syndrome Induced Psychomotor Agitation: A Pilot, Open-Label Study

A Single Dose of Asenapine for the Treatment of Bipolar Patients Affected by Withdrawal Syndrome Induced Psychomotor Agitation: A Pilot, Open-Label Study

US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014

The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer's disease

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