Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study

Examples of identified discrepancies with the treatment guidelines and clinical pharmacist recommendations in the treatment with antipsychotics (D = daily, M = monthly)

Patient number	Treatment guidelines issue	Age	Diagnoses and details	Clinical recommendations pharmacist	Final acceptance (YES/NO)
1.	4 different antipsychotics concomitantly: sulpiride, haloperidol, risperidone in quetiapine	69	Psychosis Sulpiride: 3 x 200 mg D Haloperidol: 3 x 100 mg D Risperidone: 1 x 25 mg (depot) twice M, Quetiapine: 1 x 400 mg and 1 x 100 mg D	Sulpiride and haloperidol discontinuation	NO
2.	Sulpiride and paliperidone treatment concomitantly	68	Psychosis Sulpiride: 2 x 50 mg D Paliperidone: 1 x 6 mg D	Paliperidone and sulpiride discontinuation and aripiprazole initiation	NO
3.	Clozapine and risperidone treatment concomitantly	66	Personality disorder and moderate mental retardation with behavioural disorder Clozapine: 1 x 25 mg D Risperidone: 2 x 0.25 ml D	Clozapine discontinuation	YES
4.	Quetiapine and fluphenazine treatment concomitantly in patients with diabetes	66	Moderate mental retardation with behavioural disorder Fluphenazine decanoate injection: 25 mg/mL/4 weeks Quetiapine: 3 x 200 mg D	Quetiapine discontinuation	YES
5.	Clozapine and aripiprazole treatment concomitantly in patients with seizures	65	Schizophrenia Clozapine: 2 x 200 mg D Aripiprazole: 1 x 15 mg D	Monitoring	YES
6.	Olanzapine treatment in patient with Alzheimer’s dementia	71	Undetermined organic personality and behavioural disorder due to brain disease and moderate mental retardation Olanzapine: 1 x 5 mg D	Quetiapine initiation and olanzapine discontinuation	YES
7, 8.	Domperidone and quetiapine treatment concomitantly (X potential DDI)	85 (7) 90 (8)	Undefined dementia (7) Alzheimer`s dementia (8) Quetiapine: 1 x 25 mg D (7, 8) Domperidone: 2 x 10 mg D (7, 8)	Domperidone discontinuation and ondansetron initiation	YES
9.	Haloperidol and quetiapine treatment concomitantly (X potential DDI)	90	Alzheimer`s dementia Haloperidol (2 mg/ml): 2 x 15 drops D Quetiapine: 1 x 25 mg D	Quetiapine discontinuation	NO
10.	Haloperidol and quetiapine treatment concomitantly (X potential DDI)	82	Undefined dementia Haloperidol (5 mg/ml) as needed D Quetiapine: 1 x 100 mg D	Haloperidol discontinuation	NO
11, 12.	Haloperidol and sulpiride treatment concomitantly (X potential DDI)	81 (11) 82 (12)	Dementia (11) Undefined dementia (12) Sulpiride: 3 x 50 mg D (11, 12) Haloperidol (5 mg/ml): 2 x 1 D (11) Haloperidol: 2 x 5 mg D (12)	Sulpiride and haloperidol discontinuation and quetiapine initiation	YES
13.	Promazine treatment	83	Organic mood disorders Promazine: 1 x 12.5 mg D	Promazine discontinuation and quetiapine initiation	NO
14.	Amisulpride and sulpiride treatment concomitantly (X potential DDI)	72	Organic blurred disorder and Alzheimer`s dementia Amisulpride: 2 x 50 mg D Sulpiride: 3 x 50 mg D	Amisulpride discontinuation	NO
15, 16, 17.	Quetiapine for insomnia treatment	86 (15) 76 (16) 73 (17)	Insomnia (15, 16, 17) Quetiapine: 1 x 50 mg D (15, 16) 1 x 25 mg D (17)	Quetiapine discontinuation and zolpidem initiation	YES, YES, NO
18.	Risperidone and quetiapine treatment concomitantly (X potential DDI)	85	Dementia Risperidone: 1 x 0.5 mg D Quetiapine: 1 x 50 mg D	Risperidone discontinuation	NO
19.	No clear indication for quetiapine	84	Quetiapine: 2 x 25 mg D	discontinuation Quetiapine	NO
20.	Quetiapine treatment immediately after stroke	72	After stroke condition Quetiapine: 1 x 50 mg D	Quetiapine discontinuation	YES
21.	Clozapine treatment in patient with seizures and heart rhythm disorders	84	Undefined dementia and moderate mental disorder Clozapine: 3 x 50 mg D	Clozapine discontinuation	NO