Study of Elderly Links Newer Atypical Antipsychotics with Lower Mortality Rate than Older Antipsychotic Haloperidol
Jul 13, 2004 - 5:21:00 PM
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By Pankaj, US correspondent,
[RxPG] Neurological side effects from older drugs may predispose to earlier death, newer therapies may be neuroprotective
Elderly patients whose psychosis is treated with conventional drugs may be much more likely to die than those who receive a relatively new generation of treatments, according to a study published today in the July-August issue of the American Journal of Geriatric Psychiatry (AJGP).
Researchers led by Henry A. Nasrallah, M.D., of the University of Cincinnati compared deaths during a two-year period among patients 65 years or older who were receiving either a conventional medication (haloperidol) or one of two so-called atypical therapies (risperidone or olanzapine) for Alzheimer dementia and other age-related psychoses.
Their review of patient records found that 21 percent of the patients receiving haloperidol died during the two-year period compared to a 5 percent death rate among those who were taking risperidone or olanzapine.
The findings should be of interest to those involved with geriatric care as antipsychotic medications are frequently used in the care of elderly patients suffering from various brain disorders. Antipsychotic medicines manage delusions, hallucinations, severe agitation, aggressive behavior or delirium.
Investigators say they cannot conclusively state what is behind the difference in mortality rates between those using the older versus newer treatments. But they speculate that serious neurological side effects associated with haloperidol, which include an involuntary movement disorder called Tardive Dyskinesia, could be a factor.
For example, published research has linked Tardive Dyskinesia with higher mortality rates. And, some 26 percent of elderly patients develop Tardive Dyskinesia one year after starting haloperidol therapy compared to the 2.5 percent of elderly patients using risperidone.
In addition, the study points out that depression, also associated with higher mortality, is another side effect of haloperidol while the newer antipsychotics like risperidone and olanzapine have, in fact, been shown to improve mood rather than worsen it.
Finally, the investigators observe that there is an emerging avenue of speculation that risperidone, olanzapine and other new antipsychotic medicines that have recently come on the market possess some neuroprotective properties and may improve brain structure and function in ways that allow patients to live longer.
Investigators say their results, while intriguing, should be viewed as preliminary, given such limiting factors as the lack of a control group consisting of elderly patients who were not taking any antipsychotic medications. But the researchers note that their findings suggest that the newer treatments could provide important health and safety benefits and should prompt further study.
Other investigators have already provided a powerful reason to avoid haloperidol by demonstrating that the drug is associated with a very high rate of Tardive Dyskinesia in the elderly, Nasrallah said. Our study points to another possible advantage, which is that the newer medications appear to be linked to lower mortality in the elderly.
Nasrallah said there are many reasons why some doctors still prescribe haloperidol, despite mounting evidence that newer drugs are both more effective and produce fewer damaging side effects. Reasons include the fact that the atypical antipsychotic medications have not received official approval by the Food and Drug Administration (FDA) for treating psychosis and agitation in elderly patients. So, while doctors have the legal authority to prescribe these drugs to seniors, the lack of FDA approval means that such prescriptions are technically classified as an off-label use.
Moreover, Nasrallah said in Europe the newer drugs are not as widely used due to cost considerations and because some doctors remain unconvinced that therapies like risperidone and olanzapine are significantly better. Also, he said families of patients can be reluctant to switch medications from older antipsychotics like haloperidol to one of the newer antipsychotics for fear of a relapse of symptoms, although research trials and wide clinical experience over the past decade show that such a relapse is unlikely.
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