What does this research mean for the field?

First-generation antipsychotic shortages in the United States lead to significant switching patterns among patients, with nearly 10% switching to other antipsychotics, primarily second-generation agents. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to describe the patterns of antipsychotic use following FDA-declared shortages to understand health implications.

February 28, 2026Open Access

First-generation antipsychotic shortages in the United States: Utilization and switching patterns

Key Points

The aim is to describe the patterns of antipsychotic use following FDA-declared shortages to understand health implications.
Descriptive, pre-post analysis using Komodo Healthcare Map® data from January 2016 to September 2023.
Inclusion of individuals diagnosed with a psychotic spectrum disorder with prescription claims for FGAs before shortages.
Primary outcome measured was the switching of antipsychotics defined by a medication possession ratio of at least 80%.
95,968 individuals included, predominantly taking haloperidol and perphenazine.
Switching to other antipsychotics was common, particularly for thiothixene (32.8%) and trifluoperazine (55.2%).
Time to first switch ranged from 22 to 103 days.
Shortages led to increased switches to second-generation antipsychotics.

Abstract

The United States Food and Drug Administration (FDA) has declared an increasing number of psychotropic shortages, which may adversely affect health outcomes by forcing psychotropic switches or rationing. There is a paucity of literature describing the impact of psychotropic shortages. To describe antipsychotic utilization patterns following FDA-declared antipsychotic shortages or discontinuations. This was a descriptive, pre-post analysis of the Komodo Healthcare Map® between January 2016 and September 2023. Individuals were included if they had a psychotic spectrum disorder diagnosis. Eligible individuals had a prescription drug claim for a first-generation antipsychotic (FGA) during the six months preceding the FDA-declared shortage or discontinuation date (“index date”) and a prescription drug claim for any antipsychotic in the twelve months after the index date. Individuals were excluded if the medication possession ratio (MPR) for their original shortage drug was below 80%, or if they had an inpatient hospitalization within six months of the index date. Switching was the primary outcome of interest and was defined as use of a new antipsychotic during the follow-up period with a MPR of at least 80%. All oral FGAs had at least one manufacturer shortage during the study period, with 95,968 individuals qualifying for inclusion. Most were receiving haloperidol ( n = 52,344, 54.5%) and perphenazine ( n = 16,966, 17.7%). Switching was common among individuals receiving thiothixene (32.8%), trifluoperazine (55.2%), and molindone (100%). Time to first switch ranged from 22 (standard deviation SD: 21) to 103 (SD: 66) days. Shortages of FGAs may influence patients' switching to other agents, including second generation antipsychotics. • First-generation antipsychotics have faced multiple shortages in recent years. • Nearly 10% of patients switched antipsychotics following a declared shortage. • Switching was most common for molindone (100%) and trifluoperazine (55.2%). • Most patients switched to a second-generation antipsychotic after a shortage. • Shortages can change antipsychotic utilization for treating schizophrenia.

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Cite This Study

Tabah et al. (Sun,) studied this question.

synapsesocial.com/papers/69a286240a974eb0d3c00e45 https://doi.org/https://doi.org/10.1016/j.rcsop.2026.100725

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