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Some antipsychotics more dangerous for elderly dementia patients
Antipsychotic medication should be used on elderly dementia patients only in cases of clear need, authors of a recent study said, but they found that some antipsychotics are more dangerous than others after examining data from thousands of nursing-home residents aged 65 or older.
Antipsychotic medication should be used on elderly dementia patients only in cases of clear need, authors of a recent study said, but they found that some antipsychotics are more dangerous than others after examining data from thousands of nursing-home residents aged 65 or older.
The researchers from Harvard Medical School, Rutgers University, and Columbia University found that haloperidol (Haldol, Janssen) doubled the risk of death within 180 days for elderly dementia patients when compared with other similar drugs.
Another antipsychotic, quetiapine (Seroquel, AstraZeneca), was safer than the other drugs, according to the study published February 22 in the online British Medical Journal, though the authors recommended further replication for quetiapine.
The researchers looked at 75,445 nursing-home residents from 45 states between 2001 and 2005. The design was a population-based cohort study with linked data from Medicaid, Medicare, the Minimum Data Set, the National Death Index, and a national assessment of nursing-home quality.
In addition to haloperidol and quetiapine, participants were new users of antipsychotic drugs aripiprazole (Abilify, Bristol-Myers Squibb), olanzapine (Zyprexa, Eli Lilly), risperidone (Risperdal, Janssen), and ziprasidone (Geodon, Pfizer).
The results showed that compared with risperidone, users of haloperidol had twice the risk of mortality (HR=2.07; 95% CI, 1.89-2.26) and users of quetiapine had a decreased risk (HR=0.81; 95% CI, 0.75-0.88).
The effects were strongest shortly after the start of treatment, remained after adjustment for dose, and were seen for all causes of death examined. No clinically meaningful differences were observed between risperidone and the other drugs.
Risperdone and quetiapine are both second-generation (atypical) antipsychotic drugs. Haloperidol is a first-generation (conventional) antipsychotic.
Investigators concluded that the study reinforces the important risks associated with the use of these drugs and reinforces the concept that they should not be used in the absence of clear need.
This study also reinforces 1 of the 4 focus goals (reduce the off-label use of antipsychotics by 15% by December 2012) of the 3-year Quality Initiative for long-term care proposed by the American Health Care Association/National Center for Assisted Living.
Coalition promotes important acetaminophen dosing reminders
November 18th 2014It may come as a surprise that each year Americans catch approximately 1 billion colds, and the Centers for Disease Control and Prevention estimates that as many as 20% get the flu. This cold and flu season, 7 in 10 patients will reach for an over-the-counter (OTC) medicine to treat their coughs, stuffy noses, and sniffles. It’s an important time of the year to remind patients to double check their medicine labels so they don’t double up on medicines containing acetaminophen.
Support consumer access to specialty medications through value-based insurance design
June 30th 2014The driving force behind consumer cost-sharing provisions for specialty medications is the acquisition cost and not clinical value. This appears to be true for almost all public and private health plans, says a new report from researchers at the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC).
Management of antipsychotic medication polypharmacy
June 13th 2013Within our healthcare-driven society, the increase in the identification and diagnosis of mental illnesses has led to a proportional increase in the prescribing of psychotropic medications. The prevalence of mental illnesses and subsequent treatment approaches may employ monotherapy as first-line treatment, but in many cases the use of combination of therapy can occur, leading to polypharmacy.1 Polypharmacy can be defined in several ways but it generally recognized as the use of multiple medications by one patient and the most common definition is the concurrent use of five more medications. The presence of polyharmacy has the potential to contribute to non-compliance, drug-drug interactions, medication errors, adverse events, or poor quality of life.
Medical innovation improves outcomes
June 12th 2013I have been diagnosed with stage 4 cancer of the pancreas, a disease that’s long been considered not just incurable, but almost impossible to treat-a recalcitrant disease that some practitioners feel has given oncology a bad name. I was told my life would be measured in weeks.
