Objective: To determine current patterns of use for the atypical antipsychotic ziprasidone in geriatric skilled nursing facilities (SNFs) in the United States.
Design: Retrospective analysis of claims data.
Materials and Methods: The prescription claims data repository at Omnicare, the largest provider of professional pharmacy services to US SNFs, was searched. Data on the use of oral ziprasidone, in particular, utilization rates based on different age groups, average daily doses, and concomitant medications at antipsychotic therapy initiation were identified and evaluated. All patients who received ziprasidone on a routine basis between January 2001 and November 2002, who were 65 years old or older, and whose gender was identified, were included.
Results: Utilization: Included in the analysis were 948 patients (mean and median ages 78 years); 350 (37%) were in the 65-to-74 year age group, 371 (39%) in the 75-to-84 group, and 227 (24%) were 85 years or older. Increase in use was reported in the more recent observation months compared to the earlier months (136 for March 2002, 215 for June 2002, and 255 for September 2002). Average daily doses: The average daily dose at last available dosing was 56.6 mg (SD 39.3) for the entire population. Average daily doses by age group were 67 mg (SD 43.7) in the 65-to-74 group, 53.6 (SD 36.9) in the 75-84 group, and 45.2 (SD 31.1) in the 85 or older group. Additional analyses showed that 25% of patients required dose titration; the titration period averaged 18 days. Among patients requiring dose titration, the average maximum daily dose was 58.8 mg (SD 19.7); average maximum daily doses by age group were 64.3 mg (SD 19.1) for the 65-to-74 group, 55.7 mg (SD 18.9) in the 75-to-84 group, and 56.0 mg (SD 20.3) in the 85 and older group. Average duration of treatment for all patients with titrated doses was 141 days; among patients who required dose titration and who remained in a SNF the average was 156 days. Concomitant medications: Patients were receiving three concomitant medications on average. Anxiolytics were co-prescribed to 35.9% of residents, selective serotonin reuptake inhibitors (SSRIs) to 34.1%, and miscellaneous antidepressants to 29.9%.
Conclusions: Practitioners in SNFs are adopting ziprasidone for use in elderly patients who require an antipsychotic agent, with an average daily dose of approximately 60 mg. Titration is not required in most cases. Ziprasidone is being coadministered with several other classes of drugs, including anxiolytics and antidepressants. These data suggest that ziprasidone may be a useful option in the treatment of elderly nursing home patients requiring antipsychotic therapy.
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