Monday, April 29, 2013

Garth Daniels - A Paridigm Shift, Polypharmacy and the TGA

The Therapeutic Goods Administration ( Australia) is equivalent to the Food and Drug Administration (USA).

In 2008 the TGA convened a scientific study of reports based on numerous cases submitted to it by a psychiatrist who has an interest in forensic and medico - legal issues in psychiatry. The case studies encompassed numerous reports which described adverse events and complicated psychotropic medication histories over an extended periods of time.  The scientific study was undertaken by the Psychiatric Drug Safety Expert Advisory Panel established by the TGA.

In its Executive Summary The Panel considered that "the reports were most valuable for highlighting a number of issues associated with the use of psychotropic medicines, including
  • ...extent of the problems associated with polypharmacy...
  • lack of evidence for the use of many of the prescribed combinations...
  • potential of increased adverse events when multiple medications are used concurrently...
  • clinicians difficulties in "distinguishing" side effects as akathesia from underlying psychiatric disorders
  • inconsistencies between current Australian Product Information documents and international monographs...
...there was usually clear evidence of a temporal relationship between the onset of symptoms ( e.g. akathesia or suicidal ideation ) and the use of medication and evidence that the symptom improved on discontinuation or reduction in dose of the drug...."

Why is it that on each and every occasion Garth Daniels presented to hospital...whether voluntary or involuntary is not the question... Why has it been that his drug prescription is always increased culminating in unnecessary traumatic and lengthy inpatient hospital stays?

Perhaps now there is a paradigm shift... initiated as a result of a short stay at St.Vincents Hospital and recognition that the alternative to a C-Max dose.. and polypharmacy is a reduction.

Therapeutic dose should be based on the rate of clearance the formula of which equates to dosing rate divided by drug concentration, shouldn't it ?