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Use of antipsychotics in Parkinson's disease in daily practice
Author(s) -
Van De Vijver D. A. M. C.,
Roos R. A. C.,
Jansen P. A. F.,
Porsius A. J.,
De Boer A.
Publication year - 2002
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1046/j.1365-2125.2002.161314.x
Subject(s) - clozapine , antipsychotic , medicine , haloperidol , typical antipsychotic , psychosis , parkinson's disease , schizophrenia (object oriented programming) , atypical antipsychotic , pharmacotherapy , pediatrics , psychiatry , disease , dopamine
Psychosis is an important complication of the drug treatment of Parkinson's disease (PD). Treatment of this complication is difficult, as most antipsychotics, especially haloperidol, worsen motor symptoms of PD. Only the atypical antipsychotic clozapine improves psychosis without worsening of PD [1, 2]. The aim of the study was to assess the rate of start of antipsychotics in patients with PD compared with controls. The quality of pharmacotherapy was determined by assessing which antipsychotics were started. Data came from the PHARMO database, which includes drug dispensing information for all residents of six Dutch cities. Selected were all persons aged 55 years and older who used levodopa for at least 180 days, and who started antiparkinsonian drugs at least 180 days later than entry into PHARMO. These patients were matched to at most three controls for age, gender, pharmacy, and calendar‐time. The association between the rate of start of antipsychotic drugs and PD (determined from the start of antiparkinsonian drug treatment in PD patients and the corresponding day in calendar‐time in controls) was assessed with the use of the Cox proportional hazards model. Identified were 271 patients with PD and 748 controls. During follow‐up, 38 patients and 25 controls started with an antipsychotic; relative risk 3.9 (95% CI 2.3, 6.4) ( Figure 1). Six patients received an atypical agent (16%). 1Cumulative proportion of antipsychotic starters. — controls, — Parkinson's disease. Clozapine was given to five patients with PD. No control used clozapine. Haloperidol was the most frequently prescribed antipsychotic (11 patients 29%, and 9 controls 36%). Patients with PD started antipsychotic drugs almost four times more frequently than controls. It seems that most physicians do not take into account that a patient has PD when prescribing an antipsychotic, because only 16% antipsychotic starters with PD received an atypical agent.