June 27, 2012

Prescriptions Soar for ADHD Drugs
While Dropping Overall for Children

Silver Spring, MDChildren in the United States received 7% fewer prescriptions in 2010 than in 2002, including a 14% drop in scripts for systemic antibiotics. That's according to a review in the journal Pediatrics, which also notes declines in prescriptions for therapies to treat allergies (-61%), pain (-14%), depression (-5%), and cough/cold without expectorant (-42%).

In an effort to uncover trends in outpatient prescription drug utilization by children, government researchers examined large prescription databases to determine national patterns for the U.S. pediatric population (ages 0-17 years) during the 8-year period.

With a total of 263.6 million prescriptions filled for children in 2010, not all medications showed declines. Prescribed therapeutics increased for asthma by 14%, attention-deficit/hyperactivity disorder (ADHD) by 46%, and contraception by 93%, although the last category remained small in overall numbers, according to the study.

From birth to 11 years of age, amoxicillin was the most frequently dispensed prescription. That changed with adolescence, when the psychostimulant methylphenidate began topping the list.

In terms of ADHD therapies, the review found that amphetamine/dextroamphetamine was the second most frequently dispensed formulation, although prescriptions were 15% lower in 2010 than in 2002. Prescriptions for dextroamphetamine decreased 69% between these years. At the same time, prescriptions for dexmethylphenidate, lisdexamfetamine, and guanfacine increased after 2004, while the number of atomoxetine prescriptions dispensed to pediatric patients went up between 2002 and 2004, but significantly decreased from 2004 to 2010 at a rate of 376,800 prescriptions per year.

On another issue, the survey also reveals significant off-label use of lansoprazole, with 358,000 prescriptions dispensed in 2010 for infants less than a year old, generally for gastroesophageal reflux disease (GERD). The proton pump inhibitor is not approved by the FDA for use in children under the age of 1.

Researchers maintain their data could be useful in highlighting areas for additional research in off-label use. They point out that some pediatric studies have "found that in nearly 20% of cases in which a product was used off-label in children, the product was found not to be effective at the dose used when finally studied in children. Additional information showed that children often manifest a new, more frequent, or severe form of adverse events described in adults."

A widely cited 2009 study found no difference in efficacy between lansoprazole and placebo for symptoms attributed to GERD in infants younger than 12 months but said adverse reactions such as lower respiratory tract infections occurred more frequently with lansoprazole than with placebo.

During the study period, prescriptions dispensed to adults increased 22%; 3.3 billion prescriptions were filled in 2010. The number of prescriptions for adults is increasing an average of 86 million prescriptions per year, the authors note.

U.S. Pharmacist Social Connect