title: Growth in the concurrent use of antipsychotics with other psychotropic medications in Medicaid-enrolled children.
abstract: OBJECTIVE
  Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008.
  
  
  METHODS
  Repeated cross-sectional design was used, with national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression, standardized for year, demographics, and Medicaid eligibility group, estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics.
  
  
  RESULTS
  While SGA use overall increased by 22%, 85% of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69%-89% of annual medication days). Although the highest users of concurrent SGA were participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and did not have comorbid intellectual disability (+45%).
  
  
  CONCLUSIONS
  Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.
authors.affiliation: PolicyLab at the Children's Hospital of Philadelphia.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Kreider
authors.affiliation: PolicyLab at the Children's Hospital of Philadelphia.
authors.forename: Meredith
authors.initials: M
authors.lastname: Matone
authors.affiliation: Tufts University School of Medicine.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bellonci
authors.affiliation: Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy.
authors.forename: Susan
authors.initials: S
authors.lastname: dosReis
authors.affiliation: PolicyLab at the Children's Hospital of Philadelphia, the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and the Division of General Pediatrics at the Children's Hospital of Philadelphia.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Division of General Pediatrics at the Children's Hospital of Philadelphia.
authors.forename: Yuan-Shung
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Biostatistics and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania.
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.affiliation: PolicyLab at the Children's Hospital of Philadelphia, the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and the Division of General Pediatrics at the Children's Hospital of Philadelphia. Electronic address: rubin@email.chop.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Rubin
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D019338:Polypharmacy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D011619:Psychotropic Drugs
keywords: Medicaid; foster care; pediatric psychopharmacology; polypharmacy; second-generation antipsychotics