Antipsychotics

[brianmackenna]

Placeholder as reminder. I will document

[orlamac]

Considerations for developing the codelists for antipsychotics:

NHS digital use Snomed CT 999000951000001101 when describing antipsychotic prescribing in dementia. This list includes most antipsychotics available in the UK, although it does not include cariprazine (newly licensed), loxapine (licensed for rapid tranquilisation), droperidol (used for post op nausea) and prochlorperazine. It also includes two antipsychotics that are no longer available in the UK; perphenazine and thioridazine.

We will not use the Snomed antipsychotic list as described. We intend to create codelists of antipsychotics, separated into the following categories:

- First generation antipsychotics: These will include all formulations, except for long-acting depot formulations of the following medicines: benperidol, chlorpromazine, pericyazine, trifluoperazine, sulpiride, haloperidol, promazine, pimozide, levomepromazine, zuclopenthixol, flupenthixol, prochlorperazine. Note: zuclopenthixol acetate will be included in this list as it is not intended for long acting use.

• Second generation antipsychotics: These will include all formulations, except for long acting injectable formulations, of the following medicines: amisulpride, aripiprazole, asenapine, cariprazine, loxapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone.
• Depot and long acting injectable antipsychotics: These will include the long acting depot or injectable forms of the following medicines which are used for the purposes of long term treatment: risperidone LAI, paliperidone LAI, olanzapine LAI, aripiprazole LAI, zuclopenthixol decanoate, haloperidol decanoate, flupentixol decanoate.

? Do we wish to include antipsychotics which have recently been discontinued in the UK and may still be imported from abroad for some patients e.g. piportil (pipothiazine) injection, modecate (fluphenazine) injection ?

[orlamac]

? Do we include prochlorperazine and levomepromozine even though these are used extensively for nausea and vomiting rather than psychosis. Prochlorperazine is commonly used for sedation and management of agitation in psychiatry.

[orlamac]

The following code lists have been created as a draft: First generation antipsychotics, excluding long acting depots https://codelists.opensafely.org/codelist/user/orlamac/first-generation-antipsychotics-excluding-long-acting-depots/1caf1615/

Second generation antipsychotics, excluding long acting injections: https://codelists.opensafely.org/codelist/user/orlamac/second-generation-antipsychotics-excluding-long-acting-injections/38714940/

Long acting and depot injection antipsychotics: https://codelists.opensafely.org/codelist/user/orlamac/long-acting-and-depot-injection-antipsychotics/065262d6/

[brianmackenna]

Discussion with @orlamac . @richiecroker any thoughts?

• Omit levomepromazine injections preparations (used primarily in palliative care) but keep oral in.

• Include all discontinued / imports.

• Prochlorperazine - commonly used for nausea and vomiting. However it still has (and licensed for) an antipsychotic effect so important to ensure prescribing is optimised. Propose we develop standalone prochlorperazine codelist? This means easy to combine with lists above or to analysis without.

[orlamac]

The first generation antipsychotic codelist has now been updated with prochlorperazine removed and levomepromazine injectable formulations removed.

A separate prochlorperazine codelist has been created: https://codelists.opensafely.org/codelist/user/orlamac/prochlorperazine/40898922/