Older conventional antipsychotics
are as deadly for demented elderly patients as their
atypical counterparts. That's the message the FDA sent
out to doctors in a June 16 advisory. The warning is
based largely on a pair of Canadian studies from last
year. "Health Canada is currently conducting its own
assessment," spokesman Alastair Sinclair told NRM.
"It's nice when your results make
a difference," says the lead author of one of those
studies, Queen's University geriatrician Dr Sudeep Gill.
Atypical antipsychotics were slapped
with warning labels in Canada and the US in 2005 after
earlier studies indicated they increased the mortality
risk for elderly patients with dementia. Fear that doctors
would switch back to older antipsychotics after the
warning — a fear that appears to have been well-founded
— prompted Dr Gill and his colleagues to conduct
their study, which appeared in the June 2007 issue of
the Annals of Internal Medicine.
They found that conventional antipsychotics
were probably even more deadly than atypical ones. The
most common causes of death appear to be sudden cardiac
death from arrhythmia and choking from aspiration. Both
seem to be promoted by the drug and both could easily
be attributed to "natural causes" in demented elderly
patients, says Dr Gill.
So why do physicians continue to
prescribe these dangerous meds to elderly patients?
"Though they're not terribly effective when measured
against placebo, clinicians will tell you there are
individual patients who do well on them," says Dr Gill.
"In specific niches, they do have a role. In patients
who are really psychotic — lashing out or highly
suspicious."
Dr Gill recommends that physicians
try non-pharma approaches first to treat disruptive
dementia behaviours. But he readily acknowledges that
most docs simply don't have the time nor do most facilities
have the resources to offer these approaches. "It's
going to be difficult for individual prescribers to
make a difference," says Dr Gill.
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