Certain Antipsychotics & Kidney Problems in Elderly
'Off-label' use to treat dementia-related behavior may carry significant risks, study finds
The drugs have carried a black-box warning from the FDA since 2005, after analysis of 17 randomized, controlled trials showed that older patients with dementia who took these drugs were up to 1.7 times more likely to die during the study period than those given a placebo.
Their off-label use to treat difficult behavior in the elderly has previously been linked to drowsiness, falls, weight gain and serious health conditions, including stroke, pneumonia and death from any cause. But, "this is the first time these medications have been linked in a meaningful, robust way to kidney injury," Garg said.
Using health care database records from 2003 to 2012 in Ontario, Garg and his colleagues looked at the rates of acute kidney injury and other conditions among more than 97,000 adults, aged 65 and older, in the first three months after they began taking Seroquel, Risperdal or Zyprexa. These rates were compared to those among an equal number of adults not taking the medications and matched to the first group by age, sex, living arrangements and similar health or medical conditions. Participants' average age was 81, and a little over half had dementia.
One percent of adults taking the antipsychotics were hospitalized for acute kidney injury, compared to 0.6 percent of adults not taking the medications. And 6.8 percent of adults taking the antipsychotics died from any cause, compared to 3.1 percent of adults not taking the drugs.
Garg and Porsteinsson acknowledged that these mental health medications can be appropriate for adults with true psychosis.
"There are certain situations where there is no alternative when people are psychotic, and these drugs can make a major difference in outcomes for those individuals," Porsteinsson said, "but their use has to be balanced, not used simply for sleep impairments or anxiety."
Porsteinsson said behavioral problems in adults with dementia can result from factors such as pain, hunger, undiagnosed medical conditions or environmental triggers. These should be investigated first, he said.
"Is their room too hot or too cold? Do they truly dislike their roommate in a shared room? Do they have some unmet need?" Porsteinsson suggested. "They cannot communicate their needs so there's a lot of thoughtful detective work that needs to go into this."