For the last couple of years, there have been a lot of questions raised about the cost, effectiveness, and safety of second-generation (or atypical) antipsychotic drugs such as Zyprexa, Seroquel, and Risperdal. However, a new Canadian study has found that older, conventional antipsychotic medications pose a similar risk of death to elderly patients perhaps an even greater risk than the atypical class.
A new report published in the current issue of the Canadian Medical Association Journal (CMAJ) claims that, among elderly patients, “the risk of death associated with conventional antipsychotic medications is comparable to and possibly greater than the risk of death associated with atypical antipsychotic medications. Until further evidence is available, physicians should consider all antipsychotic medications to be equally risky in elderly patients.”
Researchers studied more than 37,000 seniors and discovered that, within the first 180 days of treatment, 14.1 percent of the conventional-drug group died, compared to 9.6 percent of the atypical-drug group. Patients taking high dosages of conventional drugs faced a 67 percent increase in mortality. In addition, the study found that patients who had taken a conventional medication had a 32 percent greater (dose-dependent) risk of death within 180 days than those who were given an atypical agent.
In 2005, Health Canada, the government’s public-health watchdog, reported that atypical antipsychotic medications increased the risk of death by 60 percent in trials involving elderly patients with dementia. However, researchers were concerned that warnings about the new atypical antipsychotic drugs were causing physicians to prescribe conventional antipsychotic treatments more frequently–even though their overall safety has not been proven either.
The authors of the study believe that regulatory product warnings should be expanded to account for these new findings. “The results from our study strongly suggest that Health Canada and the FDA should include conventional antipsychotic medications in their public health advisories, which currently warn only of the increased risk of death associated with the use of atypical antipsychotic medications in elderly patients with dementia.”
They also note, “Antipsychotic medications are disproportionately used in elderly populations and have been prescribed to over a quarter of U.S. Medicare beneficiaries in nursing homes” and that “much use is outside approved indications.”