Prescribing
Section: Prescribing | LD Toolkit template | RCGP Learning
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Prescribing
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Prescribing is one of the most common inteventions for people with a learning disability. The average number of repeat prescriptions is about five, compared to one for the general population. Part of this is because of co-occuring conditions such as epilepsy but it may also be because of behaviours reported as challenging.
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About 40% of people with a learning disability take five or more medications, making medication reviews very important.
Royal Pharmaceutical Society: medication reviews
NHS Lancashire & South Cumbria: medications and my mental health
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Antipsychotics, antiepileptics and benzodiazepines are the most prescribed medicines, even when there is no underlying diagnosis of a mental health condition. Nearly 14% of people with a learning disability are on antipsychotic medication even through the majority do not have a diagnosis of a serious mental illness, compared to about 1% of the general population. Adverse outcomes from use of antipsychotic medications include movement disorders, metabolic complications and increased mortality.
University of Birmingham: medicine information - learning disabilities medication guideline
The Pharmaceutical Journal: Reducing antipsychotic prescribing in people with learning disabilities
Dr Rebecca King & Steve Rabino: anticholinergic burden calculator
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One of the reasons that people with a learning disability are more likely to be prescribed psychotropic behaviour is showing 'challenging behaviour' such as being agitated or aggressive. However the agression may not be caused by anger or a mental health problem, but due to fear, pain or being frightened. A person may not be able to communicate this, particularly if they dont have words to describe how they are feeling.
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The 'Stopping Overmedication of People with learning disabilities and autistic people programme (STOMP)' and 'Supporting Treatment and Appropriate Medication in Paediatrics' (STAMP) are NHS England initiatives to tackle concern over the widespread overuse of psychotropic medications.
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About one in five people with a learning disability also have epilepsy. An annual review of medication is important; if the epilepsy is not controlled, refer to secondary care and consider suggesting a seizure diary.
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Nearly 20% of people with a learning disability have constipation. The causes are multifactorial and prescribing guidance has been developed. There are also some helpful videos giving an overview.
NHS England: Constipation resources for people with a learning disability
NHS South West: treating constipation (Youtube video)
NHS South West: how to use macrogol laxatives (Youtube video)
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