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[Non-oral routes of administration of psychotropic agents].

For patients not able to take oral medication, a psychotropic agent may be selected not only according to its therapeutic and side effects but also to the optional alternative routes of administration. Partly because of the various options of routes of administration haloperidol is the first choice 'classic' antipsychotic medication. As to 'atypical' antipsychotics, the preparation of an ill-tasting clozapine liquid is possible. Lorazepam, clorazepate and diazepam injections (oil in water emulsion) or diazepam per rectiole are non-oral anxiolytics of first choice. Clomipramine and amitriptyline are the only parenteral antidepressants available in the Netherlands. Lithium tablets without controlled release may be administered as a suspension via a catheter. Carbamazepine or valproate may serve as a parenteral alternative for lithium. In case of extrapyramidal side effects of antipsychotics, biperiden or promethazine may be administered parenterally.

Formularies as Topic↗

Avoiding psychotropic drug interactions in the cardiovascular patient.

Recent advances in our understanding of the hepatic cytochrome P450 inhibitory effects of the newer antidepressants have increased concern about drug interactions in the practice of psychiatry. The authors summarize the potential interactions of psychoactive drugs with cardiovascular medications. Practicing psychiatrists encounter many patients with cardiovascular disease, and an awareness of these interactions will improve knowledgeable prescribing for medically ill patients with comorbid mental disorders.

Cardiovascular Agents↗

The effect of a closed formulary on prescription drug use and costs.

This study examines the effect of a closed formulary on pharmaceutical use and spending. We compared an employer plan that implemented a closed formulary in July 1997 to a control group with an open formulary, for the nine months preceding and following implementation of the formulary. When controlling for age, gender, and chronic disease score, the closed formulary was associated with significantly lower increases in utilization and expenditures, a higher prior authorization rate, and a reduced rate of continuation with chronic medications in the nine months following its implementation. These findings have implications for the design of prescription drug benefits.

Adult↗

[Approaches to improving drug supply to the population].

The official record system has been introduced at public health institutions of the Novgorod region 3 years ago. It helped regulate the drug supply at medical institutions and in the region at large.

Drug Information Services↗

The ABCs of PBMs.

Explore the source record for details and available documents.

Administrative Personnel↗

[Psychiatric complications of pharmacotherapy--a review].

Various commonly used drugs with somatic indications may give rise to a host of partially serious psychiatric side-effects. This overview details important prescribed drugs of daily use and their psychiatric complications. The problems of elderly patients are particularly considered. Also, polypharmacy will be given special attention.

Age Factors↗

Managed care cost-containment strategies and their impact on physician prescribing and treatment of depression. Based on a presentation by Robert K. Schreter, MD.

Pharmacy costs are outpacing other healthcare expenditures, with psychotropic medications accounting for 16% to 25% of the total pharmacy costs. Managed care organizations (MCOs) can be expected to exert considerable pressure to control such costs. Avenues for cost containment include changing the management and spending decisions of MCOs, influencing physician prescribing patterns, encouraging economically efficient pharmacy policies and procedures, and controlling patient access to prescription drugs. From the cost standpoint of an MCO, briefer approaches to treating depressed patients are desirable. The MCOs prefer a limited number of psychotherapeutic sessions, rapid titration and prescription of higher dosage levels of appropriate drugs, and a longer continuation phase of pharmacological treatment to avert a relapse.

Antidepressive Agents↗