Drug utilisation of antipsychotics and lithium in Sweden 2008-2021 - a nationwide study of children aged 5-17 years.

Antipsychotics are mainly used for severe psychiatric disorders. Risperidone is the only antipsychotic approved for younger children. Aripiprazole is approved for older children, ziprasidone and lurasidone for adolescents. To describe paediatric utilisation of antipsychotic drugs in Sweden. Dispensations of antipsychotic drugs to children aged 5-17 years from 2008 to 2021 were analysed using the National Prescribed Drug Register and recorded diagnoses were obtained from the National Patient Register. Overall, dispensations of antipsychotics to children increased from 16.7 to 36.9/10,000 between 2008 and 2021. The increase was larger in girls, from 12.3 to 36.6/10,000. New users of antipsychotics increased by 121% in the same period, from 7.9 to 17.5/10.000. In 2019, in children aged 12-17, 63% of girls and 71% of boys were dispensed had at least three dispensations of antipsychotics, while the corresponding proportion in children aged 5-11 were 52% for girls and 63% for boys. Risperidone was the most common drug in boys of all ages and in girls aged 5-11. In girls aged 12-17, aripiprazole and quetiapine were most common. The proportion of on-label antipsychotic use was 21% in girls and 15% in boys based in authorised product information and increased to 37% and 45%, respectively, when aligning with national guidelines. The use of antipsychotics has increased, with the proportion of girls starting treatment at the end of study period exceeding that of boys. A considerable proportion of prescriptions was off-label, even when considering national guidelines.