For patients in nursing homes, treatment with antipsychotic medicines is pretty much routine.
Though the drugs were developed to treat schizophrenia, they're also used to manage the dementia-related behavior of elderly patients. Up to a third of patients in nursing homes get the drugs, despite their risks.
The Food and Drug Administration beefed-up warnings about the newer type of antipsychotics (so-called atypicals) back in 2005, after an analysis of studies showed the risk of death among elderly patients taking them was higher than for patients getting placebos.
Three years later, the agency extended the warning to older, so-called conventional antipsychotics. Neither group of drugs has been approved by FDA to treat dementia-related psychosis, by the way.
But the broad-brush warnings didn't make any distinction among the drugs. Now a study that has looked at the experience of more than 75,000 nursing home patients has.
A key finding: People taking Haldol, an older, conventional antipsychotic, were twice as likely to die within six months of starting the drug as those taking Risperdal, a commonly used atypical.
"Use of conventionals antipsychotics is no longer justified in this population, based on the evidence," says Krista Huybrechts, lead author of the paper and an epidemiologist focused on drugs at Brigham & Women's Hospital in Boston.
There were about 109 deaths per 100 years' worth of people taking Haldol compared with 36 deaths for Risperdal, the researchers found. (So-called person years were used by the researchers to account for the varying times patients took the medicines.)
Among the newer drugs, Seroquel, or quetiapine generically, appeared to be a little safer — about 28 deaths per 100 person years. Doctors might consider that information, Huybrechts tells Shots, but the evidence for it wasn't conclusive.
The use of antipsychotics in the elderly remains controversial and unapproved by the FDA. Huybrechts says the results of the the study she and her colleagues performed shouldn't be interpreted as promoting that use. Rather, she says, the evidence could help doctors make better choices on which antipsychotic to prescribe, if that's the course that's been decided upon.