Polypharmacy in Children and Adolescents Initiating Antipsychotic Drug in 2008-2016: A Nationwide Register Study

Tiivistelmä

Objective

The use of antipsychotics in children and adolescents has increased rapidly. Little is known about psychotropic polypharmacy in children and adolescent initiating an antipsychotic drug. Thus, we investigated the frequency and predictors of polypharmacy during the first year of antipsychotic use in Finnish children and adolescents.

Methods

Between 2008 and 2016, 14 848 individuals aged 1–17 years initiating risperidone, quetiapine, aripiprazole, or olanzapine treatment were identified from Finnish Prescription Registry. Data on psychotropic drug prescriptions prior to and during antipsychotic treatment were collected. Associations between predictors and polypharmacy were analyzed with regression models.

Results

During the study period polypharmacy occurred in 44.9% of the new antipsychotic users, being more frequent in girls (55.5%) than in boys (44.5%, p < 0.001). The two most frequent concomitant psychotropic drug classes were antidepressants (66.2%) and psychostimulants/atomoxetine (30.8%). Adolescents aged 13–15 and 16–17 years, and girls showed an increased risk of polypharmacy during antipsychotic treatment (OR 2.37 [95% CI 1.91–2.92], OR 2.39 [95% CI 1.92–2.98], and OR 1.64 [95% CI 1.51–1.78], respectively). The use of psychostimulants/atomoxetine or antidepressants prior to initiation of antipsychotic treatment was strongly associated with polypharmacy during antipsychotic treatment (OR 8.39 [95% CI 7.49–9.41], OR 3.02 [95% CI 2.75–3.31]).

Conclusions

Polypharmacy was common in children and adolescents initiating antipsychotic treatment. Prior use of psychostimulants/atomoxetine and antidepressants increased the risk of polypharmacy. The use of antipsychotics was mainly off-label, thus, the risks of concomitant use of antipsychotics with other psychotropic drugs should be carefully weighed.

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Tekijät

Eveliina Varimo, Leena Saastamoinen, Hanna Rättö, Eeva T. Aronen

Lisätietoja julkaisusta

• Vertaisarvioitu: kyllä.
• Avoin saatavuus: kyllä.
• Koko viite: Varimo, E., Saastamoinen, L. K., Rättö, H., & Aronen, E. T. (2023). Polypharmacy in children and adolescents initiating antipsychotic drug in 2008-2016: a nationwide register study. Nordic journal of psychiatry, 77(1), 14–22. https://doi.org/10.1080/08039488.2022.2042597