Polypharmacy in Children on the Rise
August 1, 2005
Pediatric polypharmacy, the practice of prescribing two or more
medications for psychiatric symptoms in children, is on the rise
in the United States, raising concern about unknown side effects,
according to a new study appearing in the August issue of the
journal Psychiatry 2005.
“This is a critical issue—it’s not uncommon to
find a child on an anti-depressant, a mood stabilizer and a sleep
agent all at the same time, but there’s no research to see
how these drugs interact with each other” says co-author
Joseph Penn, MD, a child psychiatrist with the Bradley Hasbro
Children’s Research Center in Providence, RI and Brown Medical
School.
The authors reviewed ten years of scholarly articles pertaining
to polypharmacy in pediatric settings and found that all the studies
comparing these rates across time showed an increase in the practice.
However, the authors warn there are almost no studies or published
research, on which to justify prescribing multiple medications
for psychiatric disorders in children.
According to the study, the most frequent combination were stimulants
such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine,
Adderall) commonly used to treat attention deficit hyperactivity
disorder (ADHD), with another psychotropic medication.
Another contributing factor to the increased risks of prescribing
multiple drugs is the prevalence of off-label prescriptions—the
practice of prescribing a medication to children when there is
not an FDA-approved indication for that disorder in children.
“For example, aytpicals like risperidone are sometimes used
to symptomatically treat psychosis or aggression in children,
but most of these medications don’t have FDA approval for
use on psychiatric symptoms in the pediatric age group,”
says co-author Henrietta Leonard, MD, a child psychiatrist with
the Bradley Hasbro Children’s Research Center and Brown Medical
School. “We just don’t have the efficacy or safety data
to back up what is common clinical practice.”
Because there are limits to the data available on the efficacy
of a single medication in the pediatric age group, the authors
express deep concern over the rise in polypharmacy because it
could multiply the risk of adverse events.
“The FDA recently questioned whether there is a link between
the use of antidepressants in children and suicidal thoughts—if
there is so much concern over the effects of a single drug, how
much riskier is it to prescribe multiple drugs?” Penn says.
The authors cite examples of a child on two medications for ADHD
who died suddenly, and additionally describe serotonin syndrome,
a serious and potentially fatal illness that can result when a
child receives two medications with serotonergic properties.
In addition, the American Academy of Child and Adolescent Psychiatry
has issued a policy statement saying, “Little data exist
to support advantageous efficacy for drug combinations, used primarily
to treat co-morbid conditions.”
The authors concur. “We need more systematic studies to
establish the safety and efficacy of medications in the pediatric
age group,” says Penn.
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