Researchers: Antipsychotic drugs are overprescribed for Alzheimer’s patients

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A UK research study finds that prescribing antipsychotic drugs “off-label” to calm Alzheimer's patients nearly doubles the risk of patient death over three years

New antipsychotic drugs such as Risperdal, Seroquel and Zyprexa are routinely prescribed to manage aggressiveness and agitation in Alzheimer's patients. A new study finds that these antipsychotics nearly double elderly patients’ risk of death over three years, according to a new study published in the January 9 issue of Lancet Neurology.  

In a study of 165 Alzheimer's patients in the UK who were prescribed either antipsychotics or placebos, researchers found a significant increase in the risk of death for patients who continued taking the antipsychotic medication. The difference between the two groups became more pronounced over time, with 24-month survival rates for antipsychotic-treated patients falling to 46% versus 71% on the placebo and at 36 months it was 30% versus 59%. After three years, less than a third of people on antipsychotics were alive compared to nearly two-thirds that were given the placebo. The illnesses associated with over-medication for long periods include stroke, loss of brain function, Parkinsonianism and chest infections.  

The study was led by Dr. Clive Ballard of King's College in London and funded by the Alzheimer's Research Trust, a UK charity.  

"The results further highlight the need to seek less harmful alternatives for the long-term treatment of behavioral symptoms in Alzheimer's patients,” said Ballard in a written statement. “At the moment, there is still a limited place for antipsychotics in the treatment of Alzheimer's, particularly severe aggression, but the serious concerns of the drugs shown by our research emphasize the urgent need to put an end to unnecessary and prolonged prescribing." 

As any caregiver of an Alzheimer’s disease patient knows, the disease can bring some difficult symptoms: irritability, anxiety, aggressiveness, confusion and agitation. With shortages in trained staff adept at caring for Alzheimer’s patients, physicians have turned increasingly to the use of antipsychotic drugs in an effort to manage these symptoms, despite Food and Drug Administration warnings.

The FDA has not approved these drugs for Alzheimer’s patients but physicians have the discretion to prescribe them to elderly people with dementia as “off label.”  

Up to 100,000 people with dementia are prescribed antipsychotics in UK nursing homes. In the United States, between 30 and 60 percent of the 1.8 Americans living in nursing homes have been prescribed antipsychotic drugs to control their behavior, according to the Alzheimer's Association. 

If antipsychotics are used, it should only be as a last resort and for a short period of time (6-12 weeks), according to the experts. 

Citation:

The Lancet Neurology, Early Online Publication, 9 January 2009

doi:10.1016/S1474-4422(08)70295-3