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Real-life prescribing

TheYews, CPRS, Box 354, Fulbourn Hospital, Fulbourn, Cambridge CB15EF, Claire Dibben Senior House Officer, Allen Kharbteng Senior House Officer

We agree with the recent audit of Meagher & Moran (Psychiatric Bulletin, July 2003, 27, 266-270), in which they reported that real-life prescribing differs from evidence-based guidelines. Our audit of Cambridge's rehabilitation service (a tertiary referral centre) was carried out over 1 week in June 2003. Two-hundred and seventeen patients were receiving antipsychotic medication through our pharmacy: 171 received oral medication alone, 29 long-acting intramuscular medication and 17 combined oral and intramuscular medication. Similar to Meagher & Moran, we found antipsychotic polypharmacy in 56 patients (26%), but 26 of these were receiving clozapine plus adjunctive, e.g. sulpiride. Polypharmacy was evident in the in-patients, with 52% of our 58 in-patients receiving more than one antipsychotic in comparison to 16% of the 159 out-patients, implying that polypharmacy might be a transient phenomenon. No one was prescribed thioridazine or droperidol.

We found, using a percentage of the British National Formulary (BNF, 2003) maximum recommended limit, a practical method of calculating the total daily dose as two-thirds of our patients were prescribed atypical monotherapy. Sixteen of our patients (7.4%) received antipsychotics above BNF maximum limits, while Meagher & Moran found 4.9% received more than 1000 mg chlorpromazine equivalents (CPZEs). Yorston & Pinney (2002) state that there are a number of problems with the use of CPZEs and also report that there is no simple linear relationship between CPZEs and percentage of BNF maximum limits for high doses. This may account for some of the differences found. Another explanation may be the number of patients with treatment-resistant schizophrenia.

References

BRITISH NATIONAL FORMULARY (2003) British National Formulary. London: British Medical Association and The Royal Pharmaceutical Society of Great Britain.

YORSTON, G. & PINNEY, A. (2000) Chlorpromazine equivalents and percentage of British National Formulary maximum recommended dose in-patients receiving high-dose antipsychotics. Psychiatric Bulletin, 24, 130 -132.[Abstract/Free Full Text]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hynes, F. Search for Related Content PubMed Articles by Hynes, F.