Antipsychotics in children and adolescents, February 2013 & June 2013
A Report prepared by the Drug Utilisation Subcommittee (DUSC) of the Pharmaceutical Benefits Advisory Committee (PBAC)
Abstract
Use of atypical antipsychotics in children is increasing in Australia as in many other countries with increasing awareness of harms. The Australian Government subsidises antipsychotics on the Pharmaceutical Benefits Scheme for a limited number of conditions. This study aimed to examine the patterns of utilisation of subsidised antipsychotics in children and adolescents.
De-identified, patients level pharmacy claim data from 1 December 2010 to 31 December 2012 was extracted from the records of subsidised claims provided to the Australian Government by dispensing pharmacies. As the number of records was very large a 10% sample of the dataset was used for some analyses. Data elements extracted for each de-identified record were age at date of supply, gender, medicine form and strength. Prescriber type was determined from the de-identified prescriber approval number. Initiation to treatment was the first drug supply after a minimum of 12 months previously. Co-administration was assumed where the days of coverage of both drugs were evident based on dates of supply.
The percentage of children using an antipsychotic in 2012 ranged from 0.01% for children aged 4 years or less to 0.44% for adolescents 15–19 years of age. There were slightly more males than females. The most commonly prescribed drug in children aged 14 years or younger was risperidone. In older children quetiapine was most commonly dispensed and is an increasing proportion of the market. For risperidone the 1 mg tablet, then 0.5 mg tablet were the most commonly supplied peaking at 3.5/1000 10–14 years. In older children, 15–19 years, olanzapine 5 mg (1.5/1000 age group) and 10 mg (1/1000 age group) and quetiapine 25 mg (3.5/1000 age group) and 100 mg (2/1000 age group) were supplied. Quetiapine 25 mg was the most commonly prescribed drug in adolescents 15–19. Quetiapine was also equally as likely to be prescribed with an antidepressant as without, which is different to olanzapine which was more frequently supplied without an antidepressant. In the 15-19 years age group, the most common initiation pattern was quetiapine alone or added to an antidepressant. A small number of people commenced an antidepressant and antipsychotic at the same time. Only antidepressants were considered in this analysis of co-administration.
A number of results in this analysis are concerning given the potential harms associated with use of antipsychotics, even at low doses. Use of risperidone in very young patients is worrying but of low prevalence. However it is not clear initiation to risperidone remains constant even in adolescents in the 15–19 year age group. There are low levels of use of olanzapine and quetiapine in children as young as 14 years but most use is in the 15–19 year age group. Quetiapine use is increasing but appears to have a different pattern of use, which may reflect increased rates of diagnosis and pharmacological intervention but may also show increased diversion amongst adolescents. Of major concern is the high use of low dose quetiapine, presumably for ‘off-label’ use as an anxiolytic and sedative.
Full report on Antipsychotics in Children and Adolescents (PDF 841 KB)
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