Problems continue with inappropriate prescription of antipsychotic drugs

November 7, 2013, Oregon State University

Low-dose, antipsychotic medications are continuing to be widely prescribed, a new analysis suggests, even though it's likely many of the prescriptions are for conditions where there's weak evidence of their effectiveness and serious risks remain.

The problem is less severe than it used to be, due to changes in marketing of the drugs, researchers said. A $520 million settlement against the manufacturer of the medication of largest concern, quetiapine, reduced "off-label" promotion of the for conditions not approved by the FDA, and may have led to declines in this type of sub-therapeutic use.

However, an analysis of Medicaid patients from 2004-08 shows that many of these powerful medications – which are meant to be used for severe such as schizophrenia and bipolar disorder – are still being prescribed at lower doses, possibly for conditions such as anxiety, disorder and even insomnia.

The findings were made by researchers from Oregon State University, Oregon Health and Science University, the University of Colorado and Dartmouth Institute for Health Policy and Clinical Practice. They were published in Pharmacoepidemiology and Drug Safety, in work supported by the National Institutes of Health.

"The reduction in low-dose prescribing suggests there has been a decline in off-label use of quetiapine, but it's still a problem that people should be aware of," said Daniel Hartung, an associate professor in the OSU College of Pharmacy.

"In far too many cases, these drugs are being prescribed for conditions in which there's less-clear evidence of efficacy and safety," Hartung said. "Other medications are available that have been shown to work and usually cost less. And the side effects of these include serious concerns such as increases in , cholesterol, weight gain and an increased risk of diabetes."

The drugs at first were used mostly by psychiatrists treating serious mental illness, but in recent years have been much more widely administered by general practitioners. Too often that was done without careful screening of blood sugar and cholesterol, a past study found, since use of the drugs can increase the risk of diabetes in a patient population already more prone to that condition.

Quetiapine, sold under the trade name Seroquel, was one serious concern. It was promoted by its manufacturer for a range of uses not approved by the Food and Drug Administration, and widely prescribed at lower doses for dementia, post-traumatic stress, anxiety, attention deficit and insomnia. It and some other drugs have since gained approval for use in treatment-resistant depression, but in many cases the inappropriate prescription of these medications is continuing.

The investigation of this problem was prompted by state Medicaid agencies, researchers said, because of an explosion in the use of costly antipsychotic drugs from 1997 to 2007. During that period, the market more than quadrupled from $1.7 billion to $7.4 billion.

One estimate indicated that second-generation medications accounted for more than 16 percent of total Medicaid pharmacy spending.At least five state Medicaid programs are exploring policy options to curtail the use of sub-therapeutic doses of quetiapine, the researchers said in their report.

States concerned about these issues may wish to first evaluate policies that restrict potentially safer options, such as other drugs that could be used off-label as a sedative, the scientists recommended. This might avoid driving physicians toward prescribing the .

"These issues have been reported nationally and policy discussions have taken place," Hartung said. "But changes in the prescribing practices of the profession are sometimes slow to come."

Explore further: Reducing off-label use of antipsychotic medications may save money

Related Stories

Reducing off-label use of antipsychotic medications may save money

May 15, 2012
Reducing the non-FDA-approved use of antipsychotic drugs may be a way to save money while having little effect on patient care, according to a Penn State College of Medicine study.

Atypical antipsychotics may aid symptons for some off-label uses, but not others

September 27, 2011
Medical evidence suggests that psychiatric drugs known as atypical antipsychotics are effective in reducing symptoms for some off-label conditions, but not others, according to a new RAND Corporation study.

Antipsychotic drug use in children for mood, behavior disorders increases type 2 diabetes risk

August 21, 2013
Prescribing of "atypical" antipsychotic medications to children and young adults with behavioral problems or mood disorders may put them at unnecessary risk for type 2 diabetes, a Vanderbilt University Medical Center study ...

District nursing homes win high marks for quality, but antipsychotic prescribing remains problematic

October 17, 2013
The District of Columbia Department of Health (DOH) has released a study by the George Washington University School of Public Health and Health Services (SPHHS) investigating prescribing of antipsychotics to District seniors. ...

Recommended for you

In most surgery patients, length of opioid prescription, number of refills spell highest risk for misuse

January 17, 2018
The possible link between physicians' opioid prescription patterns and subsequent abuse has occupied the attention of a nation in the throes of an opioid crisis looking for ways to stem what experts have dubbed an epidemic. ...

Patients receive most opioids at the doctor's office, not the ER

January 16, 2018
Around the country, state legislatures and hospitals have tightened emergency room prescribing guidelines for opioids to curb the addiction epidemic, but a new USC study shows that approach diverts attention from the main ...

FDA bans use of opioid-containing cough meds by kids

January 12, 2018
(HealthDay)—Trying to put a dent in the ongoing opioid addiction crisis, the U.S. Food and Drug Administration on Thursday slapped strict new restrictions on the use of opioid-containing cold and cough products by kids.

Taking ibuprofen for long periods found to alter human testicular physiology

January 9, 2018
A team of researchers from Denmark and France has found that taking regular doses of the pain reliever ibuprofen over a long period of time can lead to a disorder in men called compensated hypogonadism. In their paper published ...

Nearly one-third of Canadians have used opioids: study

January 9, 2018
Nearly one in three Canadians (29 percent) have used "some form of opioids" in the past five years, according to data released Tuesday as widespread fentanyl overdoses continue to kill.

Growing opioid epidemic forcing more children into foster care

January 8, 2018
The opioid epidemic has become so severe it's considered a national public health emergency. Addiction to prescription painkillers, such as oxycodone and morphine, has contributed to a dramatic rise in overdose deaths and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.