Antipsychotics: Risk When Used in Dementia

Antipsychotics are often used in dementia patients with associated symptoms of agitation, irritability and disruptive behavior; although the FDA, several years ago, issued a black-box warning outlining an increased risk of sudden death when used in this special population group.

The risk of death in dementia patients utilizing antipsychotics varies rather widely, depending on the agent employed, according to a study published online in the British Medical Journal in late February, 2012. The study examined 75,000 nursing home patients (large sample size) with dementia for risk of possible death within six months of the initiation of antipsychotic medication. The study looked at Haldol, Seroquel and Risperdal, in particular.

Patients placed on Haldol demonstrated a doubling in their risk of mortality compared with those placed on Risperdal – while Seroquel users were significantly less likely to expire compared to the Risperdal users.

Seroquel, although seemingly safer than others in this sample, didn’t work as well in dementia patients. This finding comes as no surprise to me.

I’ve taught that Risperdal is the agent of choice within the 2nd generation antipsychotic group for years now in my Psychopharmacology seminars. It is satisfying to know that the aforementioned study seems to agree from both a safety and efficacy standpoint. This does not mean that Risperdal is void of risk, but at low dose (less than 1 or 2 mg per day) the drug has minimal side effects; whereas Haldol is prone to cause extrapyramidal symptoms, thereby exacerbating agitation and disruptive behavioral sequences in these patients.

Nondrug intervention strategies should always be utilized first in elderly dementia patients.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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