Antipsychotics Safety for Seniors

Antipsychotic drugs may cause more side effects and have fewer benefits for older adults

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Antipsychotic drugs are used to treat psychotic symptoms that show up in many disorders. But are these drugs effective for older adults?

A recent study looked at the safety and effectiveness of these drugs in people over 40. They found that many people had side effects and did not feel the drugs helped.

These researchers said low doses and short-term use of antipsychotic medications may be best for this age group.

"Tell your doctor about any Rx side effects."

Researchers at the University of California in San Diego, led by Hua Jin, MD, looked at how safe and effective some antipsychotics were for older adults. They enrolled 332 people over age 40 with psychosis related to their dementia, schizophrenia, mood disorder or post-traumatic stress disorder (PTSD).

The drug options were Abilify (aripiprazole), Zyprexa (olanzapine), Seroquel (quetiapine) and Risperdal (risperidone).

The researchers wanted to mimic clinical care. So doctors were allowed to omit one or two of the options based on what they thought would best for the patient. Then patients were randomly assigned to one of the drugs their doctor kept on the list. Their doctors were free to change the dose throughout the study as needed by the patient. They followed up with the patients every 12 weeks for up to two years.

They looked for metabolic issues, whether or not the patient stayed on the drug, the types of adverse events and their symptoms. The researchers found that many people didn’t take their drug for very long – on average they only took a drug for 26 weeks.

Only around 25 percent of people stayed on their drug through the entire two year trial.

They didn’t know the reasons for all the people who stopped taking their drug. But for those that did have a reason, 51.6 percent stopped because of side effects, 26.9 percent stopped because the medication didn’t work and 21.5 percent stopped for other reasons (which could include improved symptoms).

Also, Seroquel was taken out of the study halfway through because of a very high number of adverse events. Of the people taking Seroquel, 38.5 percent had a serious adverse event, which is a life-threatening side effect or event.

For all the drugs in the trial, 36.5 percent of people developed metabolic issue like changes in cholesterol level, changes in blood pressure, diabetes and weight gain. About 24 percent of people in the study had a serious adverse event – hospitalization, death or an emergency room visit for life threatening situation.

Non-serious adverse events are side effects that are problematic but not life threatening. About 50 percent of people in the study had a non-serious adverse event. None of the drugs caused a significant improvement in scores on a measure of psychotic symptoms.

The authors concluded that older adults may be getting the side effects and little of the help that antipsychotics offer when they take them for longer periods of time.

They recommend that low doses and short-term treatments are best.  And, for older adults, side effects should be closely monitored. The authors noted that they only looked at people over 40, so these drugs may work differently in younger people. Also, this study included a variety of disorders.

dailyrx News spoke with Carla Perissinotto, MD, a geriatric specialist, about the results of this study. She said that the study was interesting because it mimicked clinical care. But the fact that the study was complex makes it hard to draw conclusions about any one disorder.

Dr. Perissinotto said that this study calls into question the use of these drugs in older folks, but there are not any other safer or more effective options in many cases.

She said, “Most importantly for patients and families is to really question when these medications are used, look for side effects, and always use alternatives when available.”

This study was published November 27 in the Journal of Clinical Psychiatry. The study was funded by the National Institutes of Health and the Department of Veterans Affairs. Study medications were donated by the makers of the drugs: AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Janssen. One of the authors on the study reported acting as a consultant for Astra-Zeneca and Bristol Myers Squibb.

Reviewed by: 
Review Date: 
November 27, 2012
Last Updated:
July 2, 2013