Papers

How much medicine is prescribed for the side effects of psychotropics?

By Maria McIntyre, BPharm, MRPharmS, and Camilla Haw, MRCP, MRCPsych

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Maria McIntyre is clinical pharmacist and Camilla Haw is consultant psychiatrist, both at St Andrew’s Healthcare, Northampton.

Correspondence to
Maria McIntyre
Pharmacy Department,
St Andrew’s Healthcare, Billing Road, Northampton NN1 5DG

Email MMcIntyre@standrew.co.uk

ABSTRACT

OBJECTIVE — To examine the nature and frequency of medicines prescribed to forensic and rehabilitation inpatients to manage the side effects of psychotropic medicines.

SUBJECTS AND SETTING — 153 inpatients in the forensic and rehabilitation service of a large, independent psychiatric hospital.

DESIGN — A retrospective review of drug charts and case notes and a structured interview with consultant psychiatrists.

RESULTS — Of the 143 patients prescribed psychotropics, 94 (65.7 per cent) were prescribed medicines for side effects related to these drugs. Prescription of side effect medicines was associated with a higher number of psychotropic prescriptions, prescription of antipsychotics (particularly in high doses), polypharmacy and prescription of clozapine. The most common side effect medicines were those prescribed to treat extrapyramidal motor disorders (in 30.1 per cent of patients), constipation (24.5 per cent) and hypersalivation (22.4 per cent). In 38.2 per cent of cases the psychiatrist said that it would be unwise to continue with the psychotropic if the side effect medicine had to be discontinued.

CONCLUSION — When antipsychotics, especially clozapine, and multiple psychotropics are prescribed, further medicines may be required to manage their side effects. Sometimes side effect medicines will be necessary to enable safe continuation of the psychotropic. This has implications for informed patient consent. Pharmacists have an important clinical role in the multidisciplinary team, which includes advising on the management of the side effects of psychotropics.