EVALUATION OF INPATIENT DEPOT ANTIPSYCHOTIC PRESCRIBING

OBJECTIVE: To assess the use of fluphenazine decanoate and haloperidol decanoate in an inpatient setting. DESIGN: A prospective observationa l study conducted over a 3-month period. SETTING: A 400-bed state psyc hiatric hospital. INTERVENTIONS: The psychiatric pharmacy staff evalua ted the medical records and new orders of 30 consecutive patients rece iving depot antipsychotic formulations using a detailed evaluation for m and the hospital pharmacy computer database. Criteria for evaluation were derived from the medical literature and product information, and included the following areas: diagnosis, stabilization on a short-act ing form of the antipsychotic, appropriateness of dosage conversion to depot therapy, concomitant administration of short-acting antipsychot ics (and duration of concomitant medications), and plasma concentratio n monitoring. RESULTS: Only 7 patients (23%) received what would be co nsidered optimal depot antipsychotic therapy, These patients were rece iving a stable dosage of a short-acting antipsychotic prior to convers ion to depot therapy (i.e., greater than or equal to 7 d), received op timal dose conversion to a depot form, and received optimum overlap wi th a short-acting preparation (i.e., overlap less than or equal to 7 d with fluphenazine HCl and 7-30 d with haloperidol HCl). When length o f stay data were evaluated, no significant differences were observed i n patients who received optimal therapy versus those who did not. Ther e was also no difference in length of stay when the study group was co mpared with an age-, sex-, and diagnosis-matched cohort group. However , quantitatively fewer adverse effects were reported for patients whos e treatment was considered optimal on the basis of the evaluation crit eria. CONCLUSIONS: Depot antipsychotic therapy frequently did not meet the criteria for optimal use. This did not affect length of hospital stay in these individuals. However, individuals who met the criteria e xperienced quantitatively fewer adverse events.