Some antipsychotics more dangerous for elderly dementia patients

Antipsychotic medication should be used on elderly dementia patients only as a last resort, authors of a recent study said, but they found that some antipsychotics are more dangerous than others after examining data from thousands of nursing-home residents aged 65 or older.

The researchers from Harvard Medical School, Rutgers University, and Columbia University found that haloperidol (Haldol, Janssen) doubled the risk of death within 180 days for elderly dementia patients when compared with other similar drugs.

Another antipsychotic, quetiapine (Seroquel, AstraZeneca), was safer than the other drugs, according to the study published February 22 in the online British Medical Journal, though the authors recommended further replication for quetiapine.

The researchers looked at 75,445 nursing-home residents from 45 states between 2001 and 2005. The design was a population-based cohort study with linked data from Medicaid, Medicare, the Minimum Data Set, the National Death Index, and a national assessment of nursing-home quality.

In addition to haloperidol and quetiapine, participants were new users of antipsychotic drugs aripiprazole (Abilify, Bristol-Myers Squibb), olanzapine (Zyprexa, Eli Lilly), risperidone (Risperdal, Janssen), and ziprasidone (Geodon, Pfizer).

The results showed that compared with risperidone, users of haloperidol had twice the risk of mortality (HR=2.07; 95% CI, 1.89-2.26) and users of quetiapine had a decreased risk (HR=0.81; 95% CI, 0.75-0.88).

The effects were strongest shortly after the start of treatment, remained after adjustment for dose, and were seen for all causes of death examined. No clinically meaningful differences were observed between risperidone and the other drugs.

Risperdone and quetiapine are both second-generation (atypical) antipsychotic drugs. Haloperidol is a first-generation (conventional) antipsychotic.

Investigators concluded that the study reinforces the important risks associated with the use of these drugs and reinforces the concept that they should not be used in the absence of clear need.

This study also reinforces 1 of the 4 focus goals (reduce the off-label use of antipsychotics by 15% by December 2012) of the 3-year Quality Initiative for long-term care proposed by the American Health Care Association/National Center for Assisted Living.