Skip to main content
×
×
Home

Polypharmacy: saint or sinner?

  • Deji Odelola (a1) and Nadezda Ranceva (a2)
  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Polypharmacy: saint or sinner?
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Polypharmacy: saint or sinner?
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Polypharmacy: saint or sinner?
      Available formats
      ×
Abstract
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
1 Lepping, P, Harborne, GC. Polypharmacy: how bad are we really? Psychiatrist 2010; 34: 208–9.
2 Centorrino, F, Eakin, M, Bahk, WM, Kelleher, JP, Goren, J, Salvatore, P, et al. In-patient antipsychotic drug use in 1998, 1993 and 1989. Am J Psychiatry 2002; 159: 1932–5.
3 Gilmer, TP, Dolder, CR, Folsom, DP, Mastin, W, Jeste, DV. Antipsychotic polypharmacy trends among medical beneficiaries with schizophrenia in San Diego County, 1999–2004. Psychiatr Serv 2007; 58: 1007–10.
4 Tungaraza, TE, Gupta, S, Jones, J, Poole, R, Slegg, G. Polypharmacy and high-dose antipsychotic regimes in the community. Psychiatrist 2010; 34: 44–6.
5 Ranceva, N, Ashraf, W, Odelola, D. Antipsychotic polypharmacy in outpatients at Birch Hill Hospital: incidence and adherence to guidelines. J Clin Pharmacol 2010; 50: 699704.
6 Langan, J, Shajahan, P. Antipsychotic polypharmacy: review of mechanisms, mortality and management. Psychiatrist 2010; 34: 5862.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 5 *
Loading metrics...

Abstract views

Total abstract views: 23 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 19th July 2018. This data will be updated every 24 hours.

Polypharmacy: saint or sinner?

  • Deji Odelola (a1) and Nadezda Ranceva (a2)
Submit a response

eLetters

Polypharmacy: should we or shouldn�t we?

MacDara HT McCauley, Consultant psychiatrist
08 November 2010

Much has been written about how psychiatrists should manage antipsychotic polypharmacy in The Psychiatrist recently. Taylor1 could hardly be more emphatic, “evidence supporting antipsychotic polypharmacy has, if anything, diminished and evidence suggesting or demonstrating harmhas increased”. He concludes that “mounting awareness of the probable futility of antipsychotic polypharmacy is reflected in the latest guidanceissued by the National Institute for Health and Clinical Excellence”.

Lepping & Harbone2 draw attention for the need for a “more balanced view with regard to polypharmacy in a patient group that is non- responsive”. We would like to address issues raised by Odelola & Ranceva3.

Firstly, Odelola & Ranceva speculate that the persistence of antipsychotic polypharmacy despite repeated guidance against it may indicate that this is one area where clinical practice is ahead of research evidence. They continue by citing Lepping & Harbone’s point that “in the case of polypharmacy the evidence provides no support one wayor the other”- hardly a ringing endorsement of polypharmacy. Additionally,they praise the excellent recommendations by Langan & Shajahan4. In the context of their letter (Odelola & Ranceva) we would be concerned that this is potentially misleading. Langan & Shajahan urge extreme caution if one uses polypharmacy, thorough explanatory documentation, rigorous monitoring, ongoing review and conclude with the caveats that the“worrying relationship between its use and mortality” merits investigationand that it “remains more art than science”. The take home message seems to be- avoid if possible.

Furthermore, amongst the routes to antipsychotic polypharmacy, nearly all of the above references identify the failure to complete a switch from one agent to the other as a starting point for polypharmacy- this surely represents an opportunity for psychiatrists to tackle unplanned and inappropriate polypharmacy. The risks of high dose prescribing should also be borne in mind.

The fact that there are probably increasing rates of polypharmacy prescribing should not be misinterpreted as evidence in support of it- once it was doubted by many that the world was spherical! Evidence suggests that the two polypharmacy scenarios outlined in NICE5, 1. cross-tapering and 2. adding an antipsychotic to clozapine, appear reasonable. Outside these scenarios the risks versus benefits demand serious concern. We would echo Odelola & Ranceva’s call to be open-minded re polypharmacy- this would extend to entertaining the possibility that the practice should be jettisoned in many cases. To cope with any overwhelmingfeelings of therapeutic nihilism we would direct readers to Williams et al’s6 editorial.

1.Taylor D. Antipsychotic polypharmacy- confusion reigns. Psychiatrist 2010; 34:41-3.2.Lepping P, Harbone.GC. Polypharmacy: How bad are we really? Psychiatrist 2010; 34: 208-9.3.Odelola D, Ranceva N. Polypharmacy: saint or sinner? Psychiatrist 2010;34:354.4.Langan J, Shajahan P. Antipsychotic polypharmacy: review of mechanisms,mortality and management. Psychiatrist 2010; 34:58-62.5.National Institute for Health and Clinical Excellence. Schizophrenia: Core interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (Update). NICE, 2009.6.Williams L. Newton G, Roberts K, Finlayson S, Brabbins C. Clozapine- resistant schizophrenia: a positive approach. Br J Psychiatry; 2002; 181:184-7.

Rajesh Rajpal Reg North East GP Training Scheme, Elizabeth Owens Senior Registrar, National Higher Training Scheme, MacDara McCauley Consultant Psychiatrist. St. Brigid’s Hospital, Ardee, Co. Louth. Ireland.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *