A drug utilization review on mental disorders in St. Lucia and Dominica

ABSTRACT

OBJECTIVE: To conduct a prospective drug utilization review (DUR) on mental disorders in St. Lucia and Dominica. DESIGN AND METHODS: All scripts written for psychotropic drugs in the two in-patient institutions and at the largest pharmacies in both countries were reviewed to assess the frequency and appropriateness of psychotropic drug regiments against accepted treatment guidelines. Six hundred and thirty-seven (637) prescriptions written for seventy-three (73) in-patients and five hundred and sixty-four (564) out-patients were analyzed. RESULTS: The same range of drugs was used in both countries but there were marked differences in the choice of drug regiments. The top three prescriptions in St. Lucia were the combinations of chlorpromazine/trifluoperazine/trihexyphenidyl (2 percent), trifluoperazine/trihexyphenidyl (14 percent) and chlopromazine/haloperidol/trihexyphenidyl (13 percent). In Dominica, the top three prescriptions were haloperidol/benztropine (19 percent), trifluoperazine/benztropine (15 percent), and chlorpromazine/benztropine (6 percent). Overall, trifluoperazine (44 percent) followed by chlorpromazine (43 percent) were the most frequently prescribed drugs and both agents were more popular in St. Lucia than Dominica, (50 percent 34 percent) and (53 percent30 percent) respectively. On the other hand, the third top ranking drug, haloperidol (29 percent) was more popular in Dominica (34 percent) than St. Lucia (5 percent). Anticholinergic drugs were routinely prescribed concomitantly with antipsychotic drugs. CONCLUSIONS: The study revealed that the prescribing of anti-psychotic drugs was within the professionally-accepted treatment guidelines. However, the tendency to prescribe combination antipsychotic drug regiments should be re-evaluated since polypharmacy of concurrent antipsychotic drugs has no therapeutic advantage over adequate doses of a single antipsychotic agent. Conversely, routine use of anti-cholinergic drugs may require re-consideration.(Au)