Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

Introduction and objectives: There is a paucity of antipsychotic prescribing and utilization data in Pakistan that needs addressing, especially with issues of availability, affordability, gender differences, and domestic violence, to develop pertinent strategies. The objective of this study was to address these issues by describing current antipsychotic utilization patterns in Pakistan among adult patients attending tertiary care hospitals and private practitioners. Methods: A three staged approach was used including (1) assessment of total antipsychotic utilization, expenditure, and costs per unit between 2010 and 2015, (2) an in-depth retrospective study of prescribing patterns, including co-morbidities among representative hospital patients in Pakistan, and (3) assessment of the quality of prescribing against WHO targets. Results: Total use of antipsychotics increased 4.3-fold and the cost/unit increased by 13.2% during the study period. Risperidone and olanzapine were the most prescribed antipsychotics with more limited use of other typical and atypical antipsychotics. The number of medicines per encounter was 4.56. Prescription using generic instead of brand names was 21.4%. Seven per cent were prescribed more than one antipsychotic concurrently. Conclusion: There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.