Nearly one-fourth of Medicaid-insured schizophrenia patients have been taking more than one antipsychotic for longer than 2 months, according to findings from a recent study. This growing practice represents a significant discrepancy with treatment guidelines. Most guidelines do not advocate the use of multiple concurrent antipsychotics except for short-term periods (2 months) when transitioning patients to new antipsychotics.
Bradley C. Martin, Ph.D., of the University of Arkansas for Medical Sciences, and his colleagues suggest that the rising trend for polypharmacy combinations may be due to the increased availability of new antipsychotics or changing prescribing habits. Their study was supported in part by the Agency for Healthcare Research and Quality (HS10815). The researchers used California and Georgia Medicaid claims data to analyze antipsychotic medication use among patients 16 years of age and older who were diagnosed with schizophrenia between 1998 and 2000.
Overall, 40 percent of 31,435 patients used more than one antipsychotic medication, with 23 percent using multiple antipsychotics for longer than 2 months. The overall prevalence of all antipsychotic polypharmacy increased significantly from 32 percent in 1998 to 41 percent in 2000. Clozapine polypharmacy accounted for 11 percent and atypical plus conventional antipsychotics accounted for 68 percent of all long-term polypharmacy. If Georgia and California Medicaid programs required prior authorization for long-term antipsychotic polypharmacy, they could save up to $412,397 and $5,027,312 per year, respectively, suggests Dr. Martin.
See "Prevalence, trends, and factors associated with antipsychotic polypharmacy among Medicaid-eligible schizophrenia patients, 1998-2000," by Rahul Ganguly, Ph.D., Jeffrey A. Kotzan, Ph.D., L. Stephen Miller, Ph.D., and others, in the October 2004 Journal of Clinical Psychiatry 65(10), pp. 1377-1388.
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