Older antipsychotic drugs may also pose risk
For older adults, an increased risk of death previously linked to second-generation "atypical" antipsychotic drugs also occurs with the older, "conventional" antipsychotics, according to a report appearing in the Dec. 1 New England Journal of Medicine.
The new study suggests the older drugs raise risk at least as much, if not more, than the newer drugs.
"This study sharpens our awareness that every medication decision for an older person needs to be individually tailored to the circumstances," notes William Thies, Ph.D., Alzheimer's Association vice president, medical and scientific affairs. "Antipsychotic drugs are sometimes prescribed for individuals with dementia to treat behaviors such as combativeness, restlessness, agitation and paranoid thinking. These problems can be the most distressing symptoms of the disease for diagnosed individuals and their caregivers. Although every effort should be made to find non-drug strategies to address these issues, sometimes drugs need to be considered when other approaches are not effective."
In this study, researchers looked at medication records of adults age 65 and older enrolled in a Pennsylvania drug assistance plan. They identified 22,980 individuals who began taking an oral antipsychotic drug between 1994 and 2003. About 9,000 were prescribed an older, "conventional" antipsychotic drug, such as haloperidol (Haldol) or chlorpromazine (Thorazine), while nearly 14,000 took a second-generation "atypical antipsychotic" such as risperidone (Risperdal) or quetiapine (Seroquel). Those who began taking a conventional drug had a 37 percent higher risk of dying within 180 days than those on a newer drug. The risk was greatest shortly after starting treatment and tended to diminish somewhat as time passed. The records used in the study did not specify causes of death.
Several earlier studies linked the newer, "atypical" antipsychotic drugs to an increased risk of death in older adults with dementia. These earlier studies prompted the U.S. Food and Drug Administration (FDA) in April 2005 to add a warning about the increased risk to packaging for these medications. Although the warning does not currently extend to "conventional" antipsychotics, some of the earlier studies have also pointed to an increased risk with these drugs.
For more information:
- Alzheimer's Association Oct. 18, 2005 research news on the latest study linking atypical antipsychotic drugs to an increased risk of death in older adults with dementia: www.alz.org.
- Alzheimer's Association April 19, 2005 research news on FDA's advisory on risks of atypical antipsychotics for older adults with dementia: www.alz.org.
- Alzheimer's Association fact sheet on drug and non-drug approaches to treating behavioral symptoms of Alzheimer's disease.