Trends of Anticholinergics and Antipsychotics Prescribing at Chainama Hills College Hospital, Lusaka-Zambia

Abstract

Introduction:Antipsychotics are the main pharmacological treatment for psychosis. Anticholinergic drugs are sometimes prescribed with antipsychotics to treat or as prophylaxis for extrapyramidal side effects. Antipsychotic treatment guidelines recommend that anticholinergics should not be prescribed indiscriminately as prophylaxis for extrapyramidal side effects to patients using antipsychotic drugs, but only when there is high risk or evidence of extrapyramidal side effects, as they can cause significant central and peripheral side effects which have a potential to affect treatment outcomes. The objective of the study was to assess the trends in the prescribing of antipsychotics and anticholinergics.Methods:A cross sectional study was conducted at Chainama Hills College Hospital in Zambia. An open-ended questionnaire was administered to 26 prescribers and 311 files for patients were reviewed who had an antipsychotic or anticholinergic drug prescribed. The prescription pattern of patient files was compared with theNational Institute for Health and Care Excellenceguidelines as a gold standard.Results:The antipsychotic distribution showed that 76.1% were prescribed a typical antipsychotic, 18.1% an atypical antipsychotic and 5.8% were on both typical and atypical antipsychotic. 28.2% of the patients on antipsychotics were prescribed anticholinergics (Trihexyphenidyl). 46.2% of the prescribing clinicians stated that they prescribe anticholinergics when a patient develops extrapyramidal side effects rather than concurrently with antipsychotics or when a high dose of antipsychotics has been prescribed.Conclusion:The trend in antipsychotic and anticholinergic prescribing in Lusaka-Zambia were not consistent with recommended guidelines. Majority of patients are on typical antipsychotics rather than atypical antipsychotics. Most patients were administered above optimal dose of antipsychotics though polypharmacy was solemnly practiced. Recommend that further studies to explore factors contributing to this trend are conducted.