Antipschotics with dementia

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Mortality risk of individual antipsychotics in dementia

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Antipschotics with dementia

  1. 2. <ul><li>The U.S. Food and Drug Administration (FDA) has not approved any drug for treating the behavioral symptoms of dementia. </li></ul><ul><li>However, atypical antipsychotics are commonly used for off-label treatment. </li></ul><ul><li>In April 2005, the FDA issued A Black Box Warning that the use of atypical antipsychotics to treat behavioral disturbances in patients with dementia was associated with greater mortality. </li></ul><ul><li>Another FDA black box warning for conventional antipsychotics followed in June 2008. </li></ul><ul><li>Information about mortality associated with individual antipsychotic agents in patients with dementia is limited. </li></ul>
  2. 3. <ul><li>In a 2005 meta-analysis of randomized placebo-controlled trials, no greater risk of death was observed with any individual atypical antipsychotic. </li></ul><ul><li>A study comparing the most frequently prescribed antipsychotic drugs in Canada found higher 180-day mortality ratios for haloperidol and loxapine, but no difference between olanzapine and risperidone. </li></ul><ul><li>The most recent study, using case-control methodology, found that patients with dementia taking haloperidol, olanzapine, and risperidone, but not quetiapine, had short-term increases in mortality compared with patients who were not taking these agents. </li></ul>
  3. 4. <ul><li>The use of antipsychotics to treat the behavioral symptoms of dementia is associated with greater mortality. </li></ul><ul><li>The authors examined the mortality risk of individual agents to augment the limited information on individual antipsychotic risk . </li></ul>
  4. 5. <ul><li>The authors conducted a retrospective cohort study using national data from the U.S. Department of Veterans Affairs (1999–2008) for: </li></ul><ul><ul><li>The total sample included 33,604 patients. </li></ul></ul><ul><ul><li>Dementia patients age 65 and older </li></ul></ul><ul><ul><li>Began outpatient treatment with an antipsychotic (risperidone, olanzapine, quetiapine, or haloperidol) or valproic acid (as a nonantipsychotic comparison). </li></ul></ul><ul><ul><li>Individual drug groups were compared for 180-day mortality rates . </li></ul></ul>
  5. 6. <ul><li>Haloperidol was associated with the highest mortality rates. </li></ul><ul><li>Followed by risperidon, olanzapine, valproic acid and its derivatives, and finally, quetiapine. </li></ul><ul><li>The mortality risk with haloperidol was highest in the first 30 days but decreased significantly and sharply thereafter. </li></ul><ul><li>Among the other agents, mortality risk differences were most significant in the first 120 days and declined in the subsequent 60 days during follow-up. </li></ul>
  6. 8. <ul><li>Haloperidol had 1.5 times the risk of mortality of other psychotropics in patients with dementia. </li></ul><ul><li>Risperidone, valproic acid and derivatives, and olanzapine had intermediate risk, and quetiapine had the lowest risk. </li></ul><ul><li>Quetiapine was prescribed in lower doses, often for less ill patients, but was associated with increased parkinsonian symptoms. </li></ul>
  7. 9. <ul><li>Haloperidol was more frequently prescribed by nonpsychiatrists and more often in older, medically ill African Americans. </li></ul><ul><li>The increased risk of haloperidol was primarily in the first 30 days. </li></ul><ul><li>The effcacy of quetiapine in the behavioral disturbances associated with dementia is questionable, whereas risperidone and olanzapine have signifcant benefcial effects and therefore would be preferred for treatment. </li></ul><ul><li>The use of valproic acid and derivatives as alternative agents to address the neuropsychiatric symptoms of dementia may carry associated risks as well. </li></ul>

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