Newspaper article MinnPost.com

Antipsychotic Drugs Are Riskier for Older Dementia Patients Than Previously Thought, Study Finds

Newspaper article MinnPost.com

Antipsychotic Drugs Are Riskier for Older Dementia Patients Than Previously Thought, Study Finds

Article excerpt

Physicians often prescribe antipsychotic drugs to older people with dementia to control non-memory related behavioral symptoms, including agitation, aggressiveness, delusions and hallucinations.

But officials at the U.S. Food and Drug Administration (FDA) have never approved antipsychotic medications -- such as haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel) -- for that purpose. Indeed, these medicines come with a "black box" FDA warning that their use to control behavioral disturbances in people with dementia is associated with an increased risk of premature death.

Many physicians have continued to prescribe the drugs to their patients with dementia anyway, believing that the benefits -- primarily protecting patients from harming themselves or others -- outweigh the risks.

A study published Wednesday in the journal JAMA Psychiatry, however, presents troubling new evidence that those risks are significantly higher than previously reported.

A VA database

For the study, researchers from the University of Michigan, the University of Southern California and the Veterans Administration analyzed medical data of almost 91,000 U.S. veterans (mostly men) aged 65 and older with diagnosed dementia. Approximately half the patients had been treated for behavioral problems with an antipsychotic, anticonvulsant (valproic acid) or antidepressant medication; the other half didn't receive any of these drugs.

After crunching the data, the researchers found that veterans who were given antipsychotic medications had a risk of dying significantly higher than those not taking the medications. For example, 20.7 percent of the patients taking haloperidol died within six months -- 3.8 percent more than the non-users. Among the patients taking quetiapine, 11.8 percent died within six months -- 2.0 percent more than the non-users. The increased risk of death for the olanzapine and risperidone patients fell somewhere between.

These risks are two to four times higher than previously cited in the medical literature, the study's authors point out.

The new analysis also revealed that the higher the dose of an antipsychotic medication, the greater the risk of premature death.

Another troubling finding was that people prescribed haloperidol - - the riskiest of the drugs -- were more likely to be unmarried, African-American or living in facilities with fewer beds for patients.

As for the two other types of drugs used to treat behavioral problems in people with dementia -- valproic acid and antidepressants -- the researchers found that the increased risk of premature death associated with the anticonvulsants was not statistically significant and the increased risk associated with the antidepressants was only slightly higher than for non-users. …

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