A COMMUNITY PHARMACIST-LED FOLLOW-UP SUPPORT IN ANTIPSYCHOTICS-INDUCED ADVERSE EVENTS
Authors: Maehara *Masaki , Sugiyama Masayasu 
Published: February 2025

Abstract

Background
It is well-known that bothersome side effects in patients with bipolar disorder receiving antipsychotics, such as weight gain and akathisia, lead to poor adherence to these treatment regimens 1-2).

Aims and Objectives
In Japan, community pharmacists have a wide range of roles, especially the acceptance of inquiries from patients via phone calls, discussing adverse events with doctors, and suggesting alternative medication options 3). This report underscores the role of a community pharmacist in managing side effects caused by use of antipsychotics.

Methods
A 35-year-old woman received quetiapine extended-release tablets (50 mg/day), trazodone (50 mg/day), clonazepam (1 mg/day), and lamotrigine (200 mg/day), but her manic symptoms persisted. Therefore, the dose of quetiapine was increased to 62.5 mg/day, and risperidone (0.5 mg/day) was added (Day 0). Over a phone call to the pharmacist, she mentioned that she lost control of her appetite after 7 days, resulting in a gradual weight increase of 2 kg over one week (Day 14). The pharmacist then reported this via a call to the prescribing doctor and suggested switching to aripiprazole due to its lower risk of weight gain than risperidone and quetiapine. After consideration, the doctor prescribed aripiprazole (12 mg/day) instead of risperidone and quetiapine (Day 14). Both the manic symptoms and uncontrolled appetite subsequently reduced (Day 16). However, she experienced akathisia, an uncontrollable urge to move (Day 17). The community pharmacist informed doctor about these symptoms and discussed strategies for controlling akathisia, including an aripiprazole dose reduction. As a result, the dose of aripiprazole was reduced from 12 mg/day to 6 mg/day, and the dose of clonazepam was increased from 1 mg to 2 mg/day (Day 17).

Results
The akathisia symptoms gradually decreased in the patient who received aripiprazole 6 mg/day (Day 18–28). Finally, she had controlled symptoms of bipolar disorder, including hypomanic symptoms, and did not complaint of uncontrollable appetite, weight gain and symptoms of akathisia (Day 56).

Discussion & Conclusion
A recent review showed that avoiding a side effect, such as weight gain, increases the incidence of other adverse events such as akathisia 4). Similarly, in the present case, the patient experienced akathisia as a secondary adverse event after switching to aripiprazole. However, these side effects disappeared after the intervention of community pharmacist between the patient and doctor. The present case report suggested that community pharmacist-led continuous support in patients may be a prudent strategy to follow-up antipsychotic-induced adverse events.

References
1)BESSONOVA, L., VELLIGAN, D. I., WEIDEN, P. J., O'SULLIVAN, A. K., YARLAS, A., BAYLISS, M., BARANWAL, N., RYCHLEC, K., CARPENTER-CONLIN, J., DOANE, M. J. &SAJATOVIC, M. 2020.
2)Antipsychotic treatment experiences of people with bipolar I disorder: patient perspectives from an online survey. BMC Psychiatry, 20, 354.
3)NAKAGAWA, S. &KUME, N. 2017. Pharmacy Practice in Japan. Can J Hosp Pharm, 70, 232-242.
4)PILLINGER, T., HOWES, O. D., CORRELL, C. U., LEUCHT, S., HUHN, M., SCHNEIDER-THOMA, J., GAUGHRAN, F., JAUHAR, S., MCGUIRE, P. K., TAYLOR, D. M., YOUNG, A. H. &MCCUTCHEON, R. A. 2023. Antidepressant and antipsychotic side-effects and personalised prescribing: a systematic review and digital tool development. Lancet Psychiatry.