Prescriptions of second-generation antipsychotics on the rise
By Sharon Kirkey. Source: http://www.canada.com
The number of children with at least one prescription for some of the most potent psychiatric drugs on the market increased about fourfold in the course of a decade, new Canadian research has found.
Appearing in this month’s issue of the Canadian Journal of Psychiatry, the study shows a "striking" increase in the rate of the prescribing of so-called second-generation or “atypical” antipsychotics to children aged seven and older. The most common diagnoses were for attention deficit/hyperactivity disorder and conduct disorders.
While the data comes from the province of Manitoba, researchers suspect they reflect what’s occurring across the country and are urging doctors to be vigilant for serious adverse events, given the drugs’ “potential for significant harm.”
Side-effects can include dramatic weight gain, elevated blood fats and abnormal and uncontrollable muscle movements of the face, mouth and tongue.
Some of the drugs also have been linked to insulin resistance in children, a condition that increases the risk of diabetes and heart disease later in life.
Last month, Abilify became the first and only second-generation antipsychotic to receive Health Canada approval for use in children, but only for the treatment of schizophrenia in teens aged 15 to 17.
Yet the new research shows an "extremely significant" surge in off-label (meaning not Health Canada-approved) prescribing of antipsychotics to children, said lead author Silvia Alessi-Severini.
“The product monographs clearly state that their safety and efficacy has not been assessed in children, however, they were still prescribed,” said Alessi-Severini, an assistant professor in the faculty of pharmacy at the University of Manitoba in Winnipeg.
Many of the children did not even have a diagnosis for which the drugs have been approved for use in adults, she said.
Most of the prescriptions — more than 70 per cent — were written by general practitioners, and not by specialists.
The study is based on data from a Manitoba Health database that captures more than 90 per cent of the prescriptions filled in the province. Researchers looked at the number of prescriptions for antipsychotics dispensed for those aged 18 and younger between 1998 and 2008.
Overall, antipsychotic use increased from 1.9 per 1,000 in 1999, to 7.4 per 1,000 in 2008.
The total number of prescriptions for the newer antipsychotics also increased significantly, from 2,746 in 1999, to 21,320 in 2008. The drugs were used to treat children with autism and mood disorders, but the real growth was for children with a diagnosis of ADHD or conduct disorder.
Boys represented the fastest growing group of antipsychotic users, a "sex split" researchers said could reflect the fact boys are more likely than girls to be diagnosed with autism and ADHD.
The percentage of children prescribed an antipsychotic in combination with the ADHD drug methylphenidate (the active ingredient in Ritalin) also increased dramatically during the decade, from 16 per cent in 1999, to 45 per cent in 2008.
The perception has been that newer-generation antipsychotics are safer for children’s use than older versions of the drugs, “so they’ve been more freely prescribed,” Alessi-Severini said.
“The reality is that, with a larger population being exposed, a lot of adverse events are coming out,” she said.
The risks and benefits need to be carefully weighed before the drugs are used in children, she said.
skirkey