노인 치매 환자의 항정신병약물 및 항파킨슨약물 처방 현황
The Prescribing Patterns of Antipsychotic Drugs and Antiparkinsonian Drugs in Elderly Patients with Dementia
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Background: The number of patients with dementia continues to increase as the age of aging continues to grow. Psychiatric symptoms caused by senile dementia are controlled using antipsychotics. However, these antipsychotics can lead to Parkinson's disease, and abuse of dopamine derivatives such as levodopa among Parkinsonian drugs can lead to psychosis. Therefore, we evaluated the patterns of prescribed antipsychotics and antiparkinsonian drugs in patients with senile dementia. Methods: We used data from the sample of elderly patients from the Health Insurance Review and Assessment Service (HIRA-APS-2016). We analyzed the patterns of prescribing antipsychotics and antiparkinsonian drugs including prescribed daily dosage, period of prescription, and number of patients with both antipsychotics and antiparkinsonian drugs for senile dementia. Results: Among the 159,391 patients with dementia included in this analysis, 4,963 patients (3.1%) and 16,499 patients (10.4%) were prescribed typical and atypical antipsychotic drugs, respectively. The most frequently prescribed typical antipsychotic was haloperidol (4,351 patients with dementia), whereas the atypical agent was quetiapine (12,719 patients). The most frequently prescribed antiparkinsonian drugs were in the order of levodopa/carbidopa, benztropine, and ropinirole. In addition, 1,103 and 3,508 patients prescribed typical and atypical antipsychotics, respectively, were co-prescribed antiparkinsonian drugs. Conclusions: Atypical antipsychotics were the preferred prescription in patients with senile dementia. The prescription dose was relatively low; however, the average treatment duration was mostly long-term. Selection of antipsychotics and/or antiparkinsonian drugs should be made carefully in senile dementia and the causal relationship of adverse drug reactions needs further study.
Abstract
Background: The number of patients with dementia continues to increase as the age of aging continues to grow. Psychiatric symptoms caused by senile dementia are controlled using antipsychotics. However, these antipsychotics can lead to Parkinson's disease, and abuse of dopamine derivatives such as levodopa among Parkinsonian drugs can lead to psychosis. Therefore, we evaluated the patterns of prescribed antipsychotics and antiparkinsonian drugs in patients with senile dementia. Methods: We used data from the sample of elderly patients from the Health Insurance Review and Assessment Service (HIRA-APS-2016). We analyzed the patterns of prescribing antipsychotics and antiparkinsonian drugs including prescribed daily dosage, period of prescription, and number of patients with both antipsychotics and antiparkinsonian drugs for senile dementia. Results: Among the 159,391 patients with dementia included in this analysis, 4,963 patients (3.1%) and 16,499 patients (10.4%) were prescribed typical and atypical antipsychotic drugs, respectively. The most frequently prescribed typical antipsychotic was haloperidol (4,351 patients with dementia), whereas the atypical agent was quetiapine (12,719 patients). The most frequently prescribed antiparkinsonian drugs were in the order of levodopa/carbidopa, benztropine, and ropinirole. In addition, 1,103 and 3,508 patients prescribed typical and atypical antipsychotics, respectively, were co-prescribed antiparkinsonian drugs. Conclusions: Atypical antipsychotics were the preferred prescription in patients with senile dementia. The prescription dose was relatively low; however, the average treatment duration was mostly long-term. Selection of antipsychotics and/or antiparkinsonian drugs should be made carefully in senile dementia and the causal relationship of adverse drug reactions needs further study.
참고문헌 (25)
- "Demographics by age; Ministry of Health and Welfare"[URL]
- "Prevalence of dementia in Korea; Ministry of Health and Welfare"[URL]
- Sink KM, "Pharmacological treatment of neuropsychiatric symptoms of dementia : a review of the evidence", JAMA, 293, pp.596~608 (2005)
- Jeste DV, "Lower incidence of tardive dyskinesia with risperidone compared with haloperidol in older patients", J Am Geriatr Soc, 47, pp.716~719 (1999)
- Koponen M, "Risk of mortality associated with antipsychotic monotherapy and polypharmacy among community-dwelling persons with alzheimer’s disease", J Alzheimers Dis, 56, pp.107~118 (2017)
- Stanniland C, "Tolerability of atypical antipsychotics", Drug Saf, 22, pp.195~214 (2000)
- Corbett A, "Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia", BMJ, 349, pp.g6420~ (2014)
- Reus VI, "The American psychiatric association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia", Am J Psychiatry, 173, pp.543~546 (2016)
- Kuehn BM, "FDA warns antipsychotic drugs may be risky for elderly", JAMA, 293(20), pp.2462~ (2005)
- Schneider LS, "Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials", Am J Geriatr Psychiatry, 14, pp.191~210 (2006)
- Glazer WM., "Extrapyramidal side effects, tardive dyskinesia, and the concept of atypicality", J Clin Psychiatry, 61, pp.16~21 (2000)
- Lucca JM, "An adverse drug interaction of haloperidol with levodopa", Indian J Psychol Med, 37, pp.220~222 (2015)
- Bondon-Guitton E, "Drug-induced parkinsonism : a review of 17years’experience in a regional pharmacovigilance center in France", Mov Disord, 26, pp.2226~2231 (2011)
- Klaus T, "When drug therapy gets old : pharmacokinetics and pharmacodynamics in the elderly", Exp Gerontol, 38, pp.843~853 (2003)
- Kim L, "A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples", Epidemiol Health, 36, pp.e2014008~ (2014)
- "Antipsychotics in people living with dementia"[URL]
- Kochi K, "Trends in antipsychotic prescriptions for Japanese outpatients during 2006-2012 : a descriptive epidemiological study", Pharmacoepidemiol Drug Saf, 26, pp.642~656 (2017)
- Taipale H, "Antipsychotic polypharmacy among a nationwide sample of community-dwelling persons with Alzheimer’s disease", J Alzheimers Dis, 41, pp.1223~1228 (2014)
- Stephens P, "Prescribing of antipsychotics in people with dementia in acute general hospitals in England : 2010-2012", Eur Geriatr Med, 5, pp.394~398 (2014)
- Schulze J, "Prescribing of antipsychotic drugs in patients with dementia : a comparison with age-matched and sex-matched non-demented controls", Pharmacoepidemiol Drug Saf, 22, pp.1308~1316 (2013)
- 윤경일, "건강보험과 의료급여 암 환자의 의료이용 행태와 치료결과 비교", 보건정보통계학회지, 39(1), pp.42~59 (2014), 한국보건정보통계학회
- 박영희, "의료급여환자의 의료이용행태에 관한 질적 분석", 한국콘텐츠학회 논문지, 17(9), pp.39~49 (2017), 한국콘텐츠학회[DOI]
- 이용재, "노인 암환자의 건강보험과 의료급여 이용차이 분석", 한국콘텐츠학회 논문지, 11(5), pp.270~279 (2011), 한국콘텐츠학회
- Hawkins T, "Pimavanserin : A novel therapeutic option for Parkinson disease psychosis", Neurol Clin Pract, 7, pp.157~162 (2017)
- Fox SH, "Pimavanserin as treatment for Parkinson’s disease psychosis", Lancet, 383, pp.494~496 (2014)