Serious adverse drug reactions to antipsychotics in children and adolescents with multiple disabilities: Avoidability and potential cost savings by Therapeutic Drug Monitoring

Introduction Children with multiple disabilities and mental illnesses are frequently treated with antipsychotics because of ‘challenging behavior’. However, these patients are particularly susceptible to serious adverse drug reactions (sADRs). This retrospective study examined the frequency of sADRs referring to antipsychotics in minors with multiple disabilities and mental illnesses and the potential avoidability of these sADRs through therapeutic drug monitoring (TDM), as well as the potential socio-economic benefits of TDM.

Methods Patients treated at a special child and adolescent psychiatric clinic for pediatric patients with multiple disabilities between January 2017, and December 2018 were retrospectively examined on the basis of the patient file for the occurrence of sADRs (definition according to European Medicines Agency), their causality with antipsychotic treatment as well as their avoidability (Schumock criteria). Furthermore, the prolongation of the hospital stay due to sADRs was calculated as well as the cost savings estimated if TDM had been applied.

Results 102 children and adolescents who were administered at least one antipsychotic drug during inpatient treatment were identified. In 22 (21.6%) of these patients sADRs were documented with at least a possible causal relationship with the antipsychotic treatment. Eleven sADRs (50%) would have been potentially avoidable through TDM. Mitigating ADRs through TDM would have led to shorter hospitalization and thus considerable savings for health insurance companies.

Conclusion The routine implementation of TDM is urgently recommended for antipsychotic treatment in minors with multiple disabilities and mental disorders to increase drug therapy safety for this vulnerable patients.

Publication History

Article published online:
16 May 2022