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Co-prescribing of atypical and typical antipsychotics — prescribing sequence and documented outcome

Pharmacy Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ (tel: 020 7740 5040; fax: 020 7919 3448)

Declaration of interest

D.T. has received research funding from various manufacturers of atypical antipsychotics and the Department of Health, and consultancy fees and honoraria for presentations received from AstraZeneca, Janssen—Cilag, Novartis, Pfizer and Eli Lilly. S.M. has received consultancy fees and honoraria for presentations from Eli Lilly and Novartis; S.M. has received research funding from Pfizer; and E.W. has received honoraria for presentations from Eli Lilly.

AIMS AND METHOD

To evaluate patterns of antipsychotic co-prescription and to establish documented outcome, we reviewed 1441 in-patient and community prescriptions written in a large mental health trust. For patients co-prescribed regular atypical and typical antipsychotics for longer than 6 weeks, medication histories were taken and case notes examined to determine sequence of prescribing, documented outcome and reasons for co-prescription.

RESULTS

Fifty-three patients had been co-prescribed aytpical and typical antipsychotics for more than 6 weeks. In 62% of cases the atypical drug had been prescribed first and a typical drug added later. The most frequently documented reason for co-prescription was that symptoms persisted when prescribed a single antipsychotic. Clinical outcome was documented for 64% of patients: 45% of the total number treated showed some improvement, with seven of 53 patients noted to have shown improvements in psychotic symptoms.

CLINICAL IMPLICATIONS

Co-prescription of aytpical and typical antipsychotics often occurs as a consequence of poor outcome with single drug treatment. In this study there was minimal evidence to suggest that co-prescription improved outcome to an important extent. There remains little support for co-prescription of antipsychotics but considerable evidence to suggest that such practice worsens adverse effect burden. Co-prescription of atypical and typical antipsychotics should be avoided in all but very exceptional circumstances.

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