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Drug information and pharmacotherapy
DI-073 Off label use of psychotropic drugs in elderly patients with dementia in a psychogeriatric unit
  1. B Mosimann1,
  2. A Von Gunten2,
  3. A Pannatier3,
  4. P Voirol3,
  5. B Hirschi3,
  6. J Mathys2,
  7. I De Giorgi Salamun3,
  8. F Sadeghipour3
  1. 1School of Pharmaceutical Sciences, Geneva and Lausanne University, Geneva, Switzerland
  2. 2Lausanne University Hospital CHUV, Geriatric Psychiatry Service, Lausanne, Switzerland
  3. 3Lausanne University Hospital CHUV, Pharmacy Service, Lausanne, Switzerland

Abstract

Background The use of antidementia drugs indicated for the treatment of certain cognitive, behavioural and psychological symptoms related to dementia (BPSD) in elderly patients is limited because of their low efficacy. Therefore, other psychotropic drugs are commonly prescribed off-label. Data on off-label prescriptions of psychotropic drugs for BPSD are scarce.

Purpose To assess both the frequency of psychotropic prescriptions for the treatment of BPSD and the conformity of prescriptions to official Swissmedic monographs1 (OSM) and to Swiss recommendations 20142 (SR).

Material and methods Retrospective and descriptive study of patients discharged between June 1st 2013 and January 31st 2014 from the Organic Psychiatric Disorders Unit of the Geriatric Psychiatry Service of a primary and tertiary care university hospital. The number and the type of drugs prescribed were investigated and the percentage of conformity to references was analysed.

Results 835 different drugs were prescribed to the 94 patients included. The average number of drugs per patient was 9 ± 3, including 4 ± 2 psychotropic drugs. Dementia was diagnosed in 89 of them for whom 409 psychotropic prescriptions were identified.

Of these 409 prescriptions, 395 prescriptions targeted the treatment of BPSD. The conformity with OSM and SR were respectively 59.0% and 68.9% according to indication, 54.2% and 64.6% according to the route of administration, 38.0% and 38.8% according to the initial dose, 43.2% and 30.8% according to the maximum dose, 35.4% and 52.2% according to the duration of treatment.

Conclusion Patients treated in a primary and tertiary hospital due to BPSD are systematically prescribed psychotropic medication, often outside the official recommendations. This may emphasise the substantial and unmet needs of approved drugs to treat BPSD.

References

  1. Swissmedic. http://www.swissmedicinfo.ch/ (last access July 06, 2014)

  2. Savaskan, E. et al. Empfehlungen zur Diagnostik und Therapie der behavioralen und psychologischen Symptome der Demenz (BPSD). PRAXIS 2014;103:135–48

ReferencesNo conflict of interest.

https://doi.org/10.1136/ejhpharm-2015-000639.248

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