title: A drug utilization study of psychotropic drugs prescribed in the psychiatry outpatient department of a tertiary care hospital.
abstract: BACKGROUND
  Psychiatric disorders are one of the major causes of morbidity. Development of newer drugs like SSRIs and atypical antipsychotics has altered the treatment paradigms. Various factors like cost of drugs, local paradigms, etc. play a role in the selection of drug therapy and hence, affect the outcome. Keeping this in mind, we conducted a study to delineate the various drugs used in psychiatric disorders, to find discrepancies, if any, between the actual and the ideal prescribing pattern of psychotropic drugs and to conduct a cost analysis.
  
  
  METHODS
  After our institutional ethics committee approved, a retrospective cross sectional drug utilization study of 600 prescriptions was undertaken. Preparation of the protocol and conduct of the study was as per the WHO - DUS and the STROBE guidelines.
  
  
  RESULTS
  Drug use indicators - In 600 prescriptions, 1074 (88.25%) were psychotropic drugs. The utilization from the National and WHO EML was 100% and 90%, respectively. Average number of psychotropic drugs per prescription was 1.79 ± 1.02 (SD). 22.5% of the prescriptions contained psychotropic FDCs. 76.01% of drugs were prescribed by generic name. Percentage of psychotropic drugs prescribed from the hospital drug schedule and psychotropic drugs actually dispensed from the hospital drug store were 73.1% and 62.3%, respectively. Drug utilization pattern in different psychiatric disorders - Most commonly prescribed drugs for schizophrenia, bipolar disorders, depression and anxiety disorders were trifluoperazine + trihexiphenydyl (63.9%), carbamazepine (17.2%), amitriptyline (34.9%), and diazepam (23.8%), respectively. The least commonly prescribed drugs were levosulpiride (1.7%), lithium (1.3%), bupropion (4.7%) and clozapine (1.9%), respectively. The PDD/DDD ratio of three drugs - haloperidol, pimozide and amitriptyline - was equal to one. The cost borne by the hospital was 116, i.e., 65.2% of the total cost. The cost index of clozapine was 11.2.
  
  
  CONCLUSIONS
  Overall, the principles of rational prescribing were followed. The hospital drug schedule should include more SSRIs. The practice of using 1(st) generation/ typical anti-psychotics as the first line was as per current recommendations. Anti-cholinergics should be used only in selected cases of patients on anti-psychotics. The use of diazepam should be curtailed and it should be used for short term only.
authors.affiliation: Resident Doctor, Department of Pharmacology, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, India .
authors.forename: Karan B
authors.initials: KB
authors.lastname: Thakkar
authors.affiliation: Associate Professor, Department of Pharmacology, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, India .
authors.forename: Mangal M
authors.initials: MM
authors.lastname: Jain
authors.affiliation: Resident Doctor, Department of Pharmacology, Seth GS Medical College & KEM hospital , Mumbai, India .
authors.forename: Gauri
authors.initials: G
authors.lastname: Billa
authors.affiliation: Assistant Professor, Department of Pharmacology, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, India .
authors.forename: Abhijit
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Assistant Professor, Department of Pharmacology, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, India .
authors.forename: Akash A
authors.initials: AA
authors.lastname: Khobragade
keywords: ATC; DDD; Drug Utilization; PDD; Psychopharmacology