title: Changes in anticonvulsant prescribing for Australian children: implications for Quality Use of Medicines.
abstract: OBJECTIVE
  The evidence-base guiding choices between newer versus established anticonvulsants in children is limited. Inappropriate use exposes children to potentially ineffective and/or harmful medicines. Our objective is to describe recent anticonvulsant prescribing patterns in the Australian paediatric population, evaluating overall trends and extent of off-label prescribing of newer agents.
  
  
  METHODS
  Aggregated national data on 15 anticonvulsants with Pharmaceutical Benefits Scheme subsidy dispensed by community pharmacies for children aged <16 years were obtained from the Drug Utilisation Subcommittee, which is part of the Australian Government Department of Health and Ageing. We analysed trends for the five most prescribed anticonvulsants dispensed between 2002 and 2009 and off-label prescribing for agents where approved Australian product information stipulates a minimum age.
  
  
  RESULTS
  Valproate was the most frequently prescribed anticonvulsant with no marked change in prescription numbers per 1000 children aged 0-16 years (11.3-11.8 prescriptions/year). Lamotrigine was the most frequently prescribed newer anticonvulsant (7.9-9.3 prescriptions/year). Carbamazepine prescriptions decreased by 38% and topiramate prescriptions increased by 19% over the 7-year study period; 3.6% of topiramate prescriptions were off-label (by age) for children aged <2 years. Since Pharmaceutical Benefits Scheme listing in 2003, levetiracetam prescriptions increased steeply to 2.5 prescriptions/year per 1000 children in 2009; 4.2% were off-label for children aged <4 years.
  
  
  CONCLUSIONS
  The substantial reduction in carbamazepine use and corresponding increase in newer anticonvulsant prescribing, including off-label uses, raises questions about potentially suboptimal Quality Use of Medicines. Such major changes in prescribing may have important clinical and economic consequences. Further study to better understand paediatric prescribing choices and outcomes is needed.
authors: Department of Paediatric Neurology, Sydney Children's Hospital, Randwick, Australia. simon.cohen@sesiahs.health.nsw.gov.au
authors: Simon A
authors: SA
authors: Cohen
authors: John A
authors: JA
authors: Lawson
authors: Linda V
authors: LV
authors: Graudins
authors: Sallie-A
authors: SA
authors: Pearson
authors: Madlen
authors: M
authors: Gazarian
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D001315:Australia; D002648:Child; D002675:Child, Preschool; D017277:Drug Approval; D016527:Drug Costs / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D004827:Epilepsy / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D056687:Off-Label Use / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*
chemical_list: D000927:Anticonvulsants