Newer anti-psychotics may be over-prescribed

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Newer antipsychotic drugs currently approved to treat schizophrenia are being increasingly prescribed for off-label indications, according to a study published in Pharmacoepidemiology and Drug Safety. According to a 2008 physicians’ survey conducted by IMS Health, more than half of the prescriptions for these drugs — which include Johnson & Johnson's Risperdal, Eli Lilly and Co.'s Zyprexa, and Bristol-Myers Squibb and Otsuka Pharmaceutical Co.'s Abilify — were written for conditions other than schizophrenia. The data also show that antipsychotic prescriptions climbed from 6.2 million in 1995 to 16.7 million in 2008 while prescriptions for first-generation antipsychotic medications like Thorazine and Haldol fell from 5.2 million to 1 million during the same period. First generation anti-psychotic medications are known to have a range of dangerous long-term side-effects, including inducing the nerve condition known as tardive dyskinesia.

ACSH’s Jonathan Leaf believes this study’s assertions border on opinion-writing. “Simply presenting a bunch of numbers on prescription drug rates does not necessarily demonstrate that the practices are inappropriate. Many psychiatrists are looking for alternative drug therapies for their patients. For instance, they might want to offer an alternative to lithium therapy for their bipolar disorder patients because lithium can cause hypothroidism, and it presents risks for women who are pregnant. What’s more, patients generally don’t like being on it and will frequently quit using it. Some of the newer drugs may be less powerful, but for the right patients they may be more appropriate.”

ACSH's Dr. Gilbert Ross clarifies that while off-label prescriptions are not necessarily bad, “these drugs can have serious side-effects and without data supporting their efficacy, it is not a good idea to routinely prescribe them off-label. On the other hand, merely accumulating a number of such ‘off-label’ prescriptions as evidence of inappropriate prescribing is also simplistic and unjustified.”