JULY 2008


Old antipsychotics pose dangers too

Death risk warning issued for elderly demented

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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