Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study
e | 20 ago 2019
INFORMAZIONI SU QUESTO ARTICOLO
Pubblicato online: 20 ago 2019
Pagine: 155 - 164
Ricevuto: 05 mag 2019
Accettato: 12 lug 2019
DOI: https://doi.org/10.2478/gp-2019-0013
Parole chiave
© 2019 Matej Stuhec, Katja Gorenc, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Demographic data of included patients
| GENDER | NUMBER OF PATIENTS |
|---|---|
| Male | 21 |
| Female | 28 |
| 65–70 years | 8 |
| 71–80 years | 17 |
| 81–90 years | 15 |
| 90 years and more | 9 |
Examples of identified discrepancies with the treatment guidelines and clinical pharmacist recommendations in the treatment with antipsychotics (D = daily, M = monthly)
| Patient number | Treatment guidelines issue | Age | Diagnoses and details | Clinical recommendations pharmacist | Final acceptance (YES/NO) |
|---|---|---|---|---|---|
| 1. | 4 different antipsychotics concomitantly: sulpiride, haloperidol, risperidone in quetiapine | 69 | Psychosis Sulpiride: 3 x 200 mg D Haloperidol: 3 x 100 mg D Risperidone: 1 x 25 mg (depot) twice M, Quetiapine: 1 x 400 mg and 1 x 100 mg D | Sulpiride and haloperidol discontinuation | NO |
| 2. | Sulpiride and paliperidone treatment concomitantly | 68 | Psychosis Sulpiride: 2 x 50 mg D Paliperidone: 1 x 6 mg D | Paliperidone and sulpiride discontinuation and aripiprazole initiation | NO |
| 3. | Clozapine and risperidone treatment concomitantly | 66 | Personality disorder and moderate mental retardation with behavioural disorder Clozapine: 1 x 25 mg D Risperidone: 2 x 0.25 ml D | Clozapine discontinuation | YES |
| 4. | Quetiapine and fluphenazine treatment concomitantly in patients with diabetes | 66 | Moderate mental retardation with behavioural disorder Fluphenazine decanoate injection: 25 mg/mL/4 weeks Quetiapine: 3 x 200 mg D | Quetiapine discontinuation | YES |
| 5. | Clozapine and aripiprazole treatment concomitantly in patients with seizures | 65 | Schizophrenia Clozapine: 2 x 200 mg D Aripiprazole: 1 x 15 mg D | Monitoring | YES |
| 6. | Olanzapine treatment in patient with Alzheimer’s dementia | 71 | Undetermined organic personality and behavioural disorder due to brain disease and moderate mental retardation Olanzapine: 1 x 5 mg D | Quetiapine initiation and olanzapine discontinuation | YES |
| 7, 8. | Domperidone and quetiapine treatment concomitantly (X potential DDI) | 85 (7) 90 (8) | Undefined dementia (7) Alzheimer`s dementia (8) Quetiapine: 1 x 25 mg D (7, 8) Domperidone: 2 x 10 mg D (7, 8) | Domperidone discontinuation and ondansetron initiation | YES |
| 9. | Haloperidol and quetiapine treatment concomitantly (X potential DDI) | 90 | Alzheimer`s dementia Haloperidol (2 mg/ml): 2 x 15 drops D Quetiapine: 1 x 25 mg D | Quetiapine discontinuation | NO |
| 10. | Haloperidol and quetiapine treatment concomitantly (X potential DDI) | 82 | Undefined dementia Haloperidol (5 mg/ml) as needed D Quetiapine: 1 x 100 mg D | Haloperidol discontinuation | NO |
| 11, 12. | Haloperidol and sulpiride treatment concomitantly (X potential DDI) | 81 (11) 82 (12) | Dementia (11) Undefined dementia (12) Sulpiride: 3 x 50 mg D (11, 12) Haloperidol (5 mg/ml): 2 x 1 D (11) Haloperidol: 2 x 5 mg D (12) | Sulpiride and haloperidol discontinuation and quetiapine initiation | YES |
| 13. | Promazine treatment | 83 | Organic mood disorders Promazine: 1 x 12.5 mg D | Promazine discontinuation and quetiapine initiation | NO |
| 14. | Amisulpride and sulpiride treatment concomitantly (X potential DDI) | 72 | Organic blurred disorder and Alzheimer`s dementia Amisulpride: 2 x 50 mg D Sulpiride: 3 x 50 mg D | Amisulpride discontinuation | NO |
| 15, 16, 17. | Quetiapine for insomnia treatment | 86 (15) 76 (16) 73 (17) | Insomnia (15, 16, 17) Quetiapine: 1 x 50 mg D (15, 16) 1 x 25 mg D (17) | Quetiapine discontinuation and zolpidem initiation | YES, YES, NO |
| 18. | Risperidone and quetiapine treatment concomitantly (X potential DDI) | 85 | Dementia Risperidone: 1 x 0.5 mg D Quetiapine: 1 x 50 mg D | Risperidone discontinuation | NO |
| 19. | No clear indication for quetiapine | 84 | Quetiapine: 2 x 25 mg D | discontinuation Quetiapine | NO |
| 20. | Quetiapine treatment immediately after stroke | 72 | After stroke condition Quetiapine: 1 x 50 mg D | Quetiapine discontinuation | YES |
| 21. | Clozapine treatment in patient with seizures and heart rhythm disorders | 84 | Undefined dementia and moderate mental disorder Clozapine: 3 x 50 mg D | Clozapine discontinuation | NO |