Antipsychotics Pose New Risks for People With Dementia

On, Liz Szabo reports on new research showing a rise in antipsychotic prescriptions for those with dementia, despite black-box warnings against such usage: 

“The use of antipsychotic medications for people with dementia has gone up in recent years, even amid warnings. A new study suggests that these drugs — developed for conditions like bipolar disorder and schizophrenia, but sometimes prescribed for dementia — pose more risks to people with dementia than previously known.

In people ages 50 and older with dementia, taking antipsychotics more than doubled the risk of pneumonia, the most common cause of death in people with dementia. And along with the known threat of stroke, the drugs increased the risk of acute kidney injury, blood clots, bone fracture, heart attack and heart failure.

Risks are greatest in the first week after patients started antipsychotic medications, according to the study, reported by U.K. researchers in BMJ on April 17. The team analyzed health records of nearly 174,000 people in the United Kingdom diagnosed with dementia from January 1998 to May 2018. About two-thirds were women, and their average age at diagnosis was 82.

The drugs risperidone, haloperidol, quetiapine and olanzapine accounted for close to 80 percent of the antipsychotic prescriptions in the study. . . . 

Use of the drugs for people with dementia dipped after the Food and Drug Administration issued multiple “black box” warnings — its strictest safety warning — about antipsychotics because of the increased risk of stroke and death. But their use crept up during the early phase of the COVID-19 pandemic, when lockdowns disrupted daily routines and many people with dementia, including those in nursing homes, were unable to see loved ones.

Use of these drugs is especially high in nursing homes in neighborhoods with high poverty where staff levels are low.”

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