The impact of permissive and restrictive pharmaceutical policies on quetiapine dispensing: Evaluating a policy pendulum using interrupted time series analysis

Abstract

More nuanced policies are needed to ensure the appropriate access to 25-mg quetiapine for dose escalation while discouraging use for indications where the evidence of risk and benefit is unclear.

Off‐label quetiapine prescribing in general hospital inpatients: an Australian experience

“…16 The frequent prescription of low-dose quetiapine is also consistent with recent concerns in Australia about the extensive potentially inappropriate use of the 25mg quetiapine formulation alone, in the absence of dose titration (its registered indication). 6,10 Neurologists and thoracic medicine specialistis were in the top three admitting specialities prescribing quetiapine in this study, and these specialists have been found to be responsible for the greatest prevalence of potentially inappropriate prescribing (according to Beers Criteria) in a prior study. 18 This requires further investigation.…”

“…8,9 In Australia, nearly two-thirds of all community prescriptions for quetiapine are for the 25-mg tablet strength 6 with approximately three-quarters of this prescribing thought to be potentially inappropriate. 10 Harms associated with the short-term use of quetiapine include over-sedation and extrapyramidal effects, whereas there is a risk of increased serum cholesterol and triglyceride concentrations, glycaemic abnormalities and weight gain with medium-to long-term use, even at doses <200 mg. 7,11,12 Quetiapine use also places older adults at immediate risk of falls, hip fractures and cognitive decline. 13 Although much is known about the initiation and use of quetiapine in the community, few studies have examined inpatient use, and those that have tend to focus on psychiatric inpatients rather than the general hospital population.…”

Comparison of Prescribing Patterns Before and After Implementation of a National Policy to Reduce Inappropriate Alprazolam Prescribing in Australia

“…29 When refills for low-dose quetiapine were eliminated in Australia to prevent prescribing outside its approved indications, subsidized dispensing decreased overall, but there was little impact on inappropriate use. 5 Despite the reduction in subsidized alprazolam use, we cannot be certain to what extent prescribing decreased overall, as we did not have data on nonsubsidized (ie, private) prescriptions. Given alprazolam’s low cost, a shift to the private market would not be surprising, as there is little price difference between private or PBS-subsidized prescriptions for many people.…”

Extra‐medical use of antipsychotics: what can be learnt from experiences with other prescription medicines?

“…At a policy level, restrictive policies using financial or other levers such as prescription monitoring programmes may assist in improving prescribing but are a relatively blunt tool, risking unintended consequences . Given the range of available psychotropic medicines, the narrowing of one market can sometimes see displacement into another pharmaceutical market or, possibly, to illicit drugs.…”