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Atypical antipsychotics seen relatively safe for behavioral symptoms in elderly

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Among psychotropic agents administered to elderly patients for behavioral symptoms, atypical antipsychotics are safer than — or at least as safe as — other classes of drugs, according to a study reported in the Canadian Medical Association Journal online March 28.

As noted by lead author Dr. Krista F. Huybrechts, with Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues, up to two-thirds of dementia patients in nursing homes are prescribed these medications — despite concerns about safety, especially with antipsychotic use.

To compare the risk of death and major medical events after initiating psychotropic medications in this population, the authors identified a cohort of 10,900 patients admitted to nursing homes over a 10 year period in British Columbia, Canada, all of whom began psychotropic medication after admission.

Among the cohort, 1942 were treated with atypical antipsychotics, 1902 with conventional antipsychotics, 2169 received antidepressants, and 4887 were given benzodiazepines.

“We used propensity-score adjustments to control for confounders,” the researchers note. They found that, compared to atypical antipsychotics, the rate ratio for death within 180 days after treatment initiation was 1.47 for conventional antipsychotics, 1.20 for antidepressants, and 1.28 with benzodiazepines.

For femur fracture, corresponding rate ratios were 1.61, 1.29 and 0.99 (i.e., null), respectively. For heart failure, the figures were 0.91, 1.04, (both null) and 1.54, while for pneumonia the ratios were 1.03, 1.09, and 0.85.

“Our exploratory study adds to the growing evidence that conventional antipsychotics may be no safer for vulnerable older adults than atypical antipsychotics,” Dr. Huybrechts and colleagues conclude. “In addition, our findings suggest that some of the other classes of psychotropic medications may carry similar risks.”

They add, “While awaiting confirmation of these initial findings — ideally in the context of a large randomized trial — clinicians considering these medications for their older nursing home patients should weigh these increased risks against potential benefits when making prescribing decisions.”

Reference:

Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

CMAJ 2011.