Polypharmacy: how bad are we really?

Lepping, Peter; Harborne, Giles

doi:10.1192/pb.34.5.208

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…11 In an editorial which stimulated debate about additional antipsychotic prescribing in general, [12][13][14] Taylor stated that additional antipsychotic usage with clozapine is unlikely to be of value other than in the cases of cross-tapering when switching, rapid tranquillisation or specifically with the addition of aripiprazole. High-dose regimens, causing increased rates of dose-related adverse events including QT elongation, 15 can result from clozapine when used alongside other antipsychotics.…”

Section: Electrocardiogram (Ecg) Changesmentioning

confidence: 99%

Clozapine antipsychotic polypharmacy: audit of use and patient monitoring

et al. 2013

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Aims and methodWe audited prescribing within our area to ascertain how widespread the practice of antipsychotic polypharmacy using clozapine was, and whether it was being carried out within existing standards, including those of high-dose monitoring when required.ResultsData on 169 patients were reviewed in year one, rising to 193 in year three. Around 30% of patients on clozapine received additional antipsychotic medication. A disturbingly low proportion of patients on clozapine whose antipsychotic polypharmacy brought them into the high-dose range were being monitored appropriately after three audit cycles (the proportion rose from 10% in cycle 1 to 28% in cycle 3). A wide range of additional antipsychotic medications was used.Clinical implicationsClozapine antipsychotic polypharmacy was prevalent at just below a third of all patients in this review. Prescribers should be alert to the fact that clozapine antipsychotic polypharmacy can push patients into the high-dose range and ensure appropriate monitoring.

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Section: Electrocardiogram (Ecg) Changesmentioning

confidence: 99%

Clozapine antipsychotic polypharmacy: audit of use and patient monitoring

et al. 2013

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“…Polypharmacy is commonplace in the treatment of psychiatric patients. 20 Whilst this is partially due to the many comorbidities that patients with schizophrenia suffer from, and may even be beneficial in some cases, 21 polypharmacy highlights the need for psychotropic medication to be as little prone to drug–drug interactions as possible, especially in aging and multimorbid populations.…”

Section: Current Issues In Treating Schizophrenia and Bipolar Disordementioning

confidence: 99%

Paliperidone extended-release: does it have a place in antipsychotic therapy?

Gahr¹,

Kölle²,

Schönfeldt‐Lecuona³

et al. 2011

DDDT

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Paliperidone (9-hydroxy-risperidone), the active metabolite of risperidone, was approved for treating schizophrenia worldwide in 2006 as paliperidone extended-release (PER), and became the first second-generation antipsychotic specifically licensed for treating schizoaffective disorder in 2009. However, at the same time, its comparatively high cost gave rise to concerns about the cost-effectiveness of PER as compared with its precursor, risperidone. This paper reviews the existing knowledge of the pharmacology, kinetics, efficacy, tolerability, and fields of application of PER, and compares PER with risperidone in order to determine whether it has a place in antipsychotic therapy. An independent assessment of all relevant publications on PER published until July 2010 was undertaken. PER has a unique pharmacological profile, including single dosing, predominantly renal excretion, low drug–drug interaction risk, and differs from risperidone in terms of mode of action and pharmacokinetics. High-level evidence suggests that PER is efficacious and safe in schizophrenia, schizoaffective disorder, and acute manic episodes. There is a striking lack of published head-to-head comparisons between PER and risperidone, irrespective of indication. Low-level evidence shows a lower risk for hyperprolactinemia and higher patient satisfaction with PER than with risperidone. PER adds to the still limited arsenal of second-generation antipsychotics. In the absence of direct comparisons with risperidone, it remains difficult to come to a final verdict on the potential additional therapeutic benefits of PER which would justify its substantially higher costs as compared with risperidone. However, in terms of pharmacology, the available evidence cautiously suggests a place for PER in modern antipsychotic therapy.

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“…This sort of work is very much in keeping with the recent government paper, Equity and Excellence: Liberating the NHS. 2 However, we thought that the focus of the questionnaire was too narrow: it essentially only dealt with the interaction between psychiatrist and service user in an out-patient setting. A far broader perspective would need to be taken for this instrument to be used as a service satisfaction questionnaire, because patients interact with a far greater range of people and systems as they move through a given care pathway.…”

Section: Patient Satisfaction Rating Scales V Patient-related Outcommentioning

confidence: 99%

“…One study found that in the same sample of couples 28% of the women, but only 19% of their male partners, reported that their relationships were violent, suggesting underreporting in a third of men. 2 In recent years researchers have approached populations without preconceptions as to the direction of violence. Large epidemiological studies have demonstrated that domestic violence is most commonly reciprocal and that when only one partner is violent there is an excess of violent women.…”

Section: Domestic Violence Is Most Commonly Reciprocalmentioning

confidence: 99%