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Pharmacopsychiatry 2012; 45(04): 127-132
DOI: 10.1055/s-0031-1291348
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Coprescription of Levodopa with Antipsychotics in a Population of 84 596 Psychiatric Inpatients from 1994 to 2008

P. Haueis
1   Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
,
S. Russmann
1   Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
2   Zurich Center for Integrative Human Physiology (ZIHP), Zurich, Switzerland
,
O. I. Zorina
1   Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
,
R. Grohmann
3   Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
,
G. A. Kullak-Ublick
1   Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
2   Zurich Center for Integrative Human Physiology (ZIHP), Zurich, Switzerland
,
E. Jaquenoud Sirot
4   Psychiatric Services Aargau, Aargau, Switzerland
,
H. Russmann
5   Department of General and Social Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

received 07 July 2011
revised 06 October 2011

accepted 12 October 2011

Publication Date:
15 November 2011 (online)

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Abstract

Introduction:

Patients on levodopa therapy frequently require additional antipsychotic pharmacotherapy. However, consideration must be given to antagonistic interactions on dopamine receptors between levodopa and antipsychotics, and efficacy and safety of such combinations. We therefore aimed to explore the practice and rationale of coprescription between levodopa and antipsychotics in psychiatric patients.

Methods:

A descriptive retrospective study based on cross-sectional prescription data repeatedly collected from psychiatric inpatients through the international Drug Safety in Psychiatry (AMSP) program between 1994 and 2008 was undertaken.

Results:

Within a population of 84 596 psychiatric patients the prevalence of levodopa therapy was 1.0% (n=886). Among those patients on levodopa therapy 59.6% (n=528) also received antipsychotics. Quetiapine coprescription increased after its first marketing in 2000 to 45.9% in 2008. Coprescription of clozapine and olanzapine decreased from up to 25 and 22%, respectively, before to less than 10% after the introduction of quetiapine. Coprescribing of other antipsychotics remained approximately stable with average prevalences between 6 and less than 1%.

Discussion:

Quetiapine has now replaced clozapine as the most frequently coprescribed neuroleptic in psychiatric patients with levodopa therapy. This is in accordance with recent data indicating a low potential for clinically relevant interactions with levodopa and efficacy against psychosis in levodopa-treated patients. The combined use of antipsychotics other than quetiapine and clozapine with levodopa is less common and generally not supported by appropriate evidence.

Key words

antipsychotics - drug interactions - levodopa - Parkinson’s disease - restless legs syndrome - pharmacoepidemiology
 

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