Rethinking Antipsychotic Formulary Policy

In this commentary, we review recent research suggesting that (a) second-generation antipsychotics (SGAs) may be no more effective than first-generation antipsychotics (FGAs), (b) the reduced risk of EPS and tardive dyskinesia with SGAs is more weakly supported by the research literature than has be...

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Bibliographic Details
Published in:Schizophrenia bulletin 2008-03, Vol.34 (2), p.375-380
Main Authors: Rosenheck, R.A., Leslie, D.L., Busch, Susan, Rofman, Ethan S., Sernyak, Michael
Format: Article
Language:English
Subjects:
Antipsychotic Agents - therapeutic use
Biological and medical sciences
Chemistry, Pharmaceutical - legislation & jurisprudence
Health Policy
Humans
Medical sciences
Mental health
Mental Health Services - legislation & jurisprudence
Neuropharmacology
Pharmacology. Drug treatments
Prevention. Health policy. Planification
Psycholeptics: tranquillizer, neuroleptic
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychopharmacology
Public Policy
Regular
Schizophrenia - drug therapy
Social psychiatry. Ethnopsychiatry
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Summary:In this commentary, we review recent research suggesting that (a) second-generation antipsychotics (SGAs) may be no more effective than first-generation antipsychotics (FGAs), (b) the reduced risk of EPS and tardive dyskinesia with SGAs is more weakly supported by the research literature than has been appreciated, and (c) benefits may be offset by greater metabolic risks of some SGAs and their substantially greater cost. Bearing in mind, as well, that risperidone, currently the least expensive SGA, will soon be available as an even less expensive generic drug, we propose a new algorithm for maintenance antipsychotic therapy. We further outline a cautious implementation procedure that relies on standardized documentation and feedback, without a restrictive formulary that would limit physician choice. The algorithm outlined here and the process for its implementation are intended as a stimulus for discussion of potential policy responses, not as a finalized proposition.
ISSN:0586-7614
1745-1701
DOI:10.1093/schbul/sbm089