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Co-prescribing of atypical and typical antipsychotics: true rate much higher

Julian Hospital, Bowthorpe Road, Norwich NR2 3TD

Sir: Taylor et al (Psychiatric Bulletin, May 2002, 26, 170-172) rightly point out that co-prescribing may lead to poorer tolerability and increased frequency of anticholinergic effects. Particular attention was not, however, drawn to the possible cardiac side-effects of co-prescribing, especially in the light of recent evidence of antipsychotics causing QT prolongation and subsequent risk of arrhythmias and possible sudden death (Appleby et al, 2000).

I was also struck by the low rate of coprescribing, 53 out of 1441 prescriptions (4%). In my experience co-prescribing of typicals and atypicals is far more common, especially when ‘as-required’ medication is taken into account. Not including ‘as-required’ medication in the study must result in a significant understimate of the true rate of co-prescribing.

In a recent local audit of antipsychotic prescribing in a group of 160 rehabilitation patients in Norwich, 63 (39%) were prescribed atypical antipsychotics. Of these 32 (50.8%) were also prescribed a typical antipsychotic, 15 (23.8%) regularly and 17 (27.0%) on an as-required basis.

Further research is needed and justification of using a typical and atypical antipsychotic needs to be clear. In a minority of patients, co-prescribing may lead to better symptom control, but, as pointed out, it may be at the expense of increased side-effects.

References

APPLEBY, L., THOMAS, S., FERRIER, N., et al(2000) Sudden unexplained death in psychiatric in-patients. British Journal of Psychiatry, 176, 405-406.[Free Full Text]

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