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Certain Antipsychotics & Kidney Problems in Elderly

'Off-label' use to treat dementia-related behavior may carry significant risks, study finds
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WebMD News from HealthDay

By Tara Haelle

HealthDay Reporter

TUESDAY, Aug. 19, 2014 (HealthDay News) -- Kidney injury can be added to the list of possible harms related to use of three antipsychotic medications often prescribed to treat behavioral symptoms of dementia in older adults, a new study finds.

Quetiapine (Seroquel), risperidone (Risperdal) and olanzapine (Zyprexa) are approved by the U.S. Food and Drug Administration to treat bipolar disorder, schizophrenia and other serious mental disorders. They are also frequently used "off-label" to treat behavioral concerns such as aggression or agitation in seniors with Alzheimer's and similar neurodegenerative diseases.

"The side effect profile with antipsychotics is particularly concerning, so there is ample evidence to worry about their use in older adults unless they're absolutely necessary," said Dr. Anton Porsteinsson, director of Alzheimer's disease care, research and education at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y. "This is basically just one more weight on the scale in disfavor of using antipsychotics in the elderly."

The study, published Aug. 19 in Annals of Internal Medicine, found that acute kidney injury was one and a half times more likely in older adults taking Seroquel, Risperdal or Zyprexa compared to similar adults not taking these medications.

It also found that the risk of low blood pressure and acute urinary retention (the inability to empty the bladder) doubled, and the risk of death from any cause more than doubled in older adults taking these drugs. The antipsychotics were linked to an increased risk of pneumonia and heart attack as well.

Although the study doesn't prove a direct cause-and-effect relationship between these drugs and kidney damage, experts say it adds to existing concerns.

"I understand why people are turning to these medications when older people are difficult to manage and you're trying to help them live with dignity, but I think they're being used a little indiscriminately," said study researcher and epidemiologist Dr. Amit Garg, of the London Health Sciences Center in Ontario, Canada. "Many agencies have said we need to be much more cautious with their use.

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