Some Psychotropics Risky in Older Patients

[Guest guest]

http://www.medpagetoday.com/Geriatrics/Dementia/25576

Some Psychotropics Risky in Older Patients

By Bankhead, Staff Writer, MedPage Today

Published: March 28, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine.

* Note that according to the authors of this study, psychotropic

drugs are given to up to two-thirds of dementia patients in nursing

homes, in part because the effectiveness of psychosocial and

behavioral interventions remains unclear, and in part because of a

lack of other resources.

* Point out that in this retrospective "exploratory" study, the

risks of death and femur fracture with the use of atypical

antipsychotics were either comparable to or less than those

associated with antipsychotics, antidepressants, and

benzodiazepines.

Psychotropic drugs are often used to control behavioral symptoms in

nursing-home residents, but data on almost 11,000 older patients

found a significantly increased risk of death and other adverse

outcomes in those treated with conventional antipsychotic drugs,

antidepressants, and benzodiazepines, compared with atypical

antipsychotic drugs.

Treatment with conventional antipsychotics increased the relative

risk of death by 47% and femur fractures by 61%, reported Krista F.

Huybrechts, PhD, of Brigham and Women's Hospital and Harvard Medical

School in Boston, and colleagues.

Benzodiazepines were associated with a 54% increased risk of heart

failure, while antidepressant users had a 20% to 30% increased risk

of death and femur fracture, Huybrechts and co-authors wrote online

in CMAJ.

"Our exploratory study adds to the growing evidence that

conventional antipsychotics may be no safer for vulnerable older

adults than atypical antipsychotics," the investigators concluded.

"In addition, our findings suggest that some of the other classes of

psychotropic medications may carry similar risks," the team wrote.

"While awaiting confirmation of these initial findings -- ideally in

the context of a large randomized trial -- clinicians considering

these medications for their older nursing home patients should weigh

these risks against potential benefits when making prescribing

decisions," Huybrechts and colleagues added.

Older adults with behavioral symptoms often receive psychotropic

medications because of the resource requirements and questionable

benefits of behavioral and psychosocial interventions.

Older patients receive these medications despite concerns about the

drugs' safety -- and the FDA and Health Canada have issued

advisories regarding increased risks of stroke and transient

ischemic attacks with certain atypical antipsychotics, the authors

noted.

Both atypical and conventional antipsychotics have also been linked

to an increased risk of death, possibly prompting clinicians to

prescribe alternative psychotropics to manage behavioral symptoms in

older patients, the authors added.

Studies on the comparative safety of other classes of psychotropic

medications have not been conducted.

As an alternative to a randomized trial, Huybrechts and colleagues

performed a pharmacoepidemiologic study to examine the associations

between various classes of psychotropic medications and unintended

health outcomes.

They analyzed prescription and medical records of patients ages 65

and older admitted to nursing homes in British Columbia from 1996 to

2006, finding 10,900 patients who had initiated treatment with

psychotropic drugs during that period.

The patients in the study cohort had a mean age of about 84.

The authors found that atypical antipsychotics accounted for 1,942

new prescriptions in the study population, conventional

antipsychotics for 1,902 prescriptions, antidepressants for 2,169,

and benzodiazepines for 4,887.

The analysis also revealed a shift in prescribing patterns for

antipsychotic medications during 2000 to 2006 compared with 1996 to

2000.

Among patients treated with conventional antipsychotics, two-thirds

of prescriptions were initiated during the earlier period -- whereas

three-fourths of prescriptions for atypical antipsychotics were

initiated after 2000.

Use of antidepressants did not change during the study period, but

55% of benzodiazepines were used during the first half of the study

period.

The authors reported that 181 patients treated with atypical

antipsychotics died during 664.3 person-years of follow-up,

translating into a rate of 27.3 deaths per 100 person-years.

Rates for the other classes of psychotropic medications were 38.8

for conventional antipsychotics, 32.9 for antidepressants, and 40.9

for benzodiazepines, respectively.

Compared with atypical antipsychotics, use of conventional

antipsychotics was associated with a significantly higher adjusted

mortality risk (RR 1.47, 1.14 to 1.91) and increased risk of femur

fractures (RR 1.61, 1.03 to 2.51).

Patients treated with antidepressants had a 20% increased risk of

mortality compared with users of atypical antidepressants (1.20,

0.96 to 1.50) and a 29% increased risk of femur fracture (RR 1.29,

0.86 to 1.94).

Benzodiazepines were associated with a 28% greater mortality risk

compared with atypical antipsychotics (RR 1.28, 1.04 to 1.58) and a

54% increased risk of heart failure (RR 1.54, 0.89 to 2.67).

The authors cautioned that their findings come with all the

limitations of a retrospective, population-based study.

Ascertainment of outcomes other than mortality also lacked

precision, they noted. For example, not taking drugs obtained with

filled prescriptions could lead to erroneous classification.

Additionally, because of limitations in population size and outcome

rates, potential differences among drugs in the same class, or among

different doses of the same drug, could not be examined, further

limiting the findings.

The authors had no relevant disclosures.

[Guest guest]

http://www.medpagetoday.com/Geriatrics/Dementia/25576

Some Psychotropics Risky in Older Patients

By Bankhead, Staff Writer, MedPage Today

Published: March 28, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine.

* Note that according to the authors of this study, psychotropic

drugs are given to up to two-thirds of dementia patients in nursing

homes, in part because the effectiveness of psychosocial and

behavioral interventions remains unclear, and in part because of a

lack of other resources.

* Point out that in this retrospective "exploratory" study, the

risks of death and femur fracture with the use of atypical

antipsychotics were either comparable to or less than those

associated with antipsychotics, antidepressants, and

benzodiazepines.

Psychotropic drugs are often used to control behavioral symptoms in

nursing-home residents, but data on almost 11,000 older patients

found a significantly increased risk of death and other adverse

outcomes in those treated with conventional antipsychotic drugs,

antidepressants, and benzodiazepines, compared with atypical

antipsychotic drugs.

Treatment with conventional antipsychotics increased the relative

risk of death by 47% and femur fractures by 61%, reported Krista F.

Huybrechts, PhD, of Brigham and Women's Hospital and Harvard Medical

School in Boston, and colleagues.

Benzodiazepines were associated with a 54% increased risk of heart

failure, while antidepressant users had a 20% to 30% increased risk

of death and femur fracture, Huybrechts and co-authors wrote online

in CMAJ.

"Our exploratory study adds to the growing evidence that

conventional antipsychotics may be no safer for vulnerable older

adults than atypical antipsychotics," the investigators concluded.

"In addition, our findings suggest that some of the other classes of

psychotropic medications may carry similar risks," the team wrote.

"While awaiting confirmation of these initial findings -- ideally in

the context of a large randomized trial -- clinicians considering

these medications for their older nursing home patients should weigh

these risks against potential benefits when making prescribing

decisions," Huybrechts and colleagues added.

Older adults with behavioral symptoms often receive psychotropic

medications because of the resource requirements and questionable

benefits of behavioral and psychosocial interventions.

Older patients receive these medications despite concerns about the

drugs' safety -- and the FDA and Health Canada have issued

advisories regarding increased risks of stroke and transient

ischemic attacks with certain atypical antipsychotics, the authors

noted.

Both atypical and conventional antipsychotics have also been linked

to an increased risk of death, possibly prompting clinicians to

prescribe alternative psychotropics to manage behavioral symptoms in

older patients, the authors added.

Studies on the comparative safety of other classes of psychotropic

medications have not been conducted.

As an alternative to a randomized trial, Huybrechts and colleagues

performed a pharmacoepidemiologic study to examine the associations

between various classes of psychotropic medications and unintended

health outcomes.

They analyzed prescription and medical records of patients ages 65

and older admitted to nursing homes in British Columbia from 1996 to

2006, finding 10,900 patients who had initiated treatment with

psychotropic drugs during that period.

The patients in the study cohort had a mean age of about 84.

The authors found that atypical antipsychotics accounted for 1,942

new prescriptions in the study population, conventional

antipsychotics for 1,902 prescriptions, antidepressants for 2,169,

and benzodiazepines for 4,887.

The analysis also revealed a shift in prescribing patterns for

antipsychotic medications during 2000 to 2006 compared with 1996 to

2000.

Among patients treated with conventional antipsychotics, two-thirds

of prescriptions were initiated during the earlier period -- whereas

three-fourths of prescriptions for atypical antipsychotics were

initiated after 2000.

Use of antidepressants did not change during the study period, but

55% of benzodiazepines were used during the first half of the study

period.

The authors reported that 181 patients treated with atypical

antipsychotics died during 664.3 person-years of follow-up,

translating into a rate of 27.3 deaths per 100 person-years.

Rates for the other classes of psychotropic medications were 38.8

for conventional antipsychotics, 32.9 for antidepressants, and 40.9

for benzodiazepines, respectively.

Compared with atypical antipsychotics, use of conventional

antipsychotics was associated with a significantly higher adjusted

mortality risk (RR 1.47, 1.14 to 1.91) and increased risk of femur

fractures (RR 1.61, 1.03 to 2.51).

Patients treated with antidepressants had a 20% increased risk of

mortality compared with users of atypical antidepressants (1.20,

0.96 to 1.50) and a 29% increased risk of femur fracture (RR 1.29,

0.86 to 1.94).

Benzodiazepines were associated with a 28% greater mortality risk

compared with atypical antipsychotics (RR 1.28, 1.04 to 1.58) and a

54% increased risk of heart failure (RR 1.54, 0.89 to 2.67).

The authors cautioned that their findings come with all the

limitations of a retrospective, population-based study.

Ascertainment of outcomes other than mortality also lacked

precision, they noted. For example, not taking drugs obtained with

filled prescriptions could lead to erroneous classification.

Additionally, because of limitations in population size and outcome

rates, potential differences among drugs in the same class, or among

different doses of the same drug, could not be examined, further

limiting the findings.

The authors had no relevant disclosures.

[Guest guest]

http://www.medpagetoday.com/Geriatrics/Dementia/25576

Some Psychotropics Risky in Older Patients

By Bankhead, Staff Writer, MedPage Today

Published: March 28, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine.

* Note that according to the authors of this study, psychotropic

drugs are given to up to two-thirds of dementia patients in nursing

homes, in part because the effectiveness of psychosocial and

behavioral interventions remains unclear, and in part because of a

lack of other resources.

* Point out that in this retrospective "exploratory" study, the

risks of death and femur fracture with the use of atypical

antipsychotics were either comparable to or less than those

associated with antipsychotics, antidepressants, and

benzodiazepines.

Psychotropic drugs are often used to control behavioral symptoms in

nursing-home residents, but data on almost 11,000 older patients

found a significantly increased risk of death and other adverse

outcomes in those treated with conventional antipsychotic drugs,

antidepressants, and benzodiazepines, compared with atypical

antipsychotic drugs.

Treatment with conventional antipsychotics increased the relative

risk of death by 47% and femur fractures by 61%, reported Krista F.

Huybrechts, PhD, of Brigham and Women's Hospital and Harvard Medical

School in Boston, and colleagues.

Benzodiazepines were associated with a 54% increased risk of heart

failure, while antidepressant users had a 20% to 30% increased risk

of death and femur fracture, Huybrechts and co-authors wrote online

in CMAJ.

"Our exploratory study adds to the growing evidence that

conventional antipsychotics may be no safer for vulnerable older

adults than atypical antipsychotics," the investigators concluded.

"In addition, our findings suggest that some of the other classes of

psychotropic medications may carry similar risks," the team wrote.

"While awaiting confirmation of these initial findings -- ideally in

the context of a large randomized trial -- clinicians considering

these medications for their older nursing home patients should weigh

these risks against potential benefits when making prescribing

decisions," Huybrechts and colleagues added.

Older adults with behavioral symptoms often receive psychotropic

medications because of the resource requirements and questionable

benefits of behavioral and psychosocial interventions.

Older patients receive these medications despite concerns about the

drugs' safety -- and the FDA and Health Canada have issued

advisories regarding increased risks of stroke and transient

ischemic attacks with certain atypical antipsychotics, the authors

noted.

Both atypical and conventional antipsychotics have also been linked

to an increased risk of death, possibly prompting clinicians to

prescribe alternative psychotropics to manage behavioral symptoms in

older patients, the authors added.

Studies on the comparative safety of other classes of psychotropic

medications have not been conducted.

As an alternative to a randomized trial, Huybrechts and colleagues

performed a pharmacoepidemiologic study to examine the associations

between various classes of psychotropic medications and unintended

health outcomes.

They analyzed prescription and medical records of patients ages 65

and older admitted to nursing homes in British Columbia from 1996 to

2006, finding 10,900 patients who had initiated treatment with

psychotropic drugs during that period.

The patients in the study cohort had a mean age of about 84.

The authors found that atypical antipsychotics accounted for 1,942

new prescriptions in the study population, conventional

antipsychotics for 1,902 prescriptions, antidepressants for 2,169,

and benzodiazepines for 4,887.

The analysis also revealed a shift in prescribing patterns for

antipsychotic medications during 2000 to 2006 compared with 1996 to

2000.

Among patients treated with conventional antipsychotics, two-thirds

of prescriptions were initiated during the earlier period -- whereas

three-fourths of prescriptions for atypical antipsychotics were

initiated after 2000.

Use of antidepressants did not change during the study period, but

55% of benzodiazepines were used during the first half of the study

period.

The authors reported that 181 patients treated with atypical

antipsychotics died during 664.3 person-years of follow-up,

translating into a rate of 27.3 deaths per 100 person-years.

Rates for the other classes of psychotropic medications were 38.8

for conventional antipsychotics, 32.9 for antidepressants, and 40.9

for benzodiazepines, respectively.

Compared with atypical antipsychotics, use of conventional

antipsychotics was associated with a significantly higher adjusted

mortality risk (RR 1.47, 1.14 to 1.91) and increased risk of femur

fractures (RR 1.61, 1.03 to 2.51).

Patients treated with antidepressants had a 20% increased risk of

mortality compared with users of atypical antidepressants (1.20,

0.96 to 1.50) and a 29% increased risk of femur fracture (RR 1.29,

0.86 to 1.94).

Benzodiazepines were associated with a 28% greater mortality risk

compared with atypical antipsychotics (RR 1.28, 1.04 to 1.58) and a

54% increased risk of heart failure (RR 1.54, 0.89 to 2.67).

The authors cautioned that their findings come with all the

limitations of a retrospective, population-based study.

Ascertainment of outcomes other than mortality also lacked

precision, they noted. For example, not taking drugs obtained with

filled prescriptions could lead to erroneous classification.

Additionally, because of limitations in population size and outcome

rates, potential differences among drugs in the same class, or among

different doses of the same drug, could not be examined, further

limiting the findings.

The authors had no relevant disclosures.

[Guest guest]

http://www.medpagetoday.com/Geriatrics/Dementia/25576

Some Psychotropics Risky in Older Patients

By Bankhead, Staff Writer, MedPage Today

Published: March 28, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine.

* Note that according to the authors of this study, psychotropic

drugs are given to up to two-thirds of dementia patients in nursing

homes, in part because the effectiveness of psychosocial and

behavioral interventions remains unclear, and in part because of a

lack of other resources.

* Point out that in this retrospective "exploratory" study, the

risks of death and femur fracture with the use of atypical

antipsychotics were either comparable to or less than those

associated with antipsychotics, antidepressants, and

benzodiazepines.

Psychotropic drugs are often used to control behavioral symptoms in

nursing-home residents, but data on almost 11,000 older patients

found a significantly increased risk of death and other adverse

outcomes in those treated with conventional antipsychotic drugs,

antidepressants, and benzodiazepines, compared with atypical

antipsychotic drugs.

Treatment with conventional antipsychotics increased the relative

risk of death by 47% and femur fractures by 61%, reported Krista F.

Huybrechts, PhD, of Brigham and Women's Hospital and Harvard Medical

School in Boston, and colleagues.

Benzodiazepines were associated with a 54% increased risk of heart

failure, while antidepressant users had a 20% to 30% increased risk

of death and femur fracture, Huybrechts and co-authors wrote online

in CMAJ.

"Our exploratory study adds to the growing evidence that

conventional antipsychotics may be no safer for vulnerable older

adults than atypical antipsychotics," the investigators concluded.

"In addition, our findings suggest that some of the other classes of

psychotropic medications may carry similar risks," the team wrote.

"While awaiting confirmation of these initial findings -- ideally in

the context of a large randomized trial -- clinicians considering

these medications for their older nursing home patients should weigh

these risks against potential benefits when making prescribing

decisions," Huybrechts and colleagues added.

Older adults with behavioral symptoms often receive psychotropic

medications because of the resource requirements and questionable

benefits of behavioral and psychosocial interventions.

Older patients receive these medications despite concerns about the

drugs' safety -- and the FDA and Health Canada have issued

advisories regarding increased risks of stroke and transient

ischemic attacks with certain atypical antipsychotics, the authors

noted.

Both atypical and conventional antipsychotics have also been linked

to an increased risk of death, possibly prompting clinicians to

prescribe alternative psychotropics to manage behavioral symptoms in

older patients, the authors added.

Studies on the comparative safety of other classes of psychotropic

medications have not been conducted.

As an alternative to a randomized trial, Huybrechts and colleagues

performed a pharmacoepidemiologic study to examine the associations

between various classes of psychotropic medications and unintended

health outcomes.

They analyzed prescription and medical records of patients ages 65

and older admitted to nursing homes in British Columbia from 1996 to

2006, finding 10,900 patients who had initiated treatment with

psychotropic drugs during that period.

The patients in the study cohort had a mean age of about 84.

The authors found that atypical antipsychotics accounted for 1,942

new prescriptions in the study population, conventional

antipsychotics for 1,902 prescriptions, antidepressants for 2,169,

and benzodiazepines for 4,887.

The analysis also revealed a shift in prescribing patterns for

antipsychotic medications during 2000 to 2006 compared with 1996 to

2000.

Among patients treated with conventional antipsychotics, two-thirds

of prescriptions were initiated during the earlier period -- whereas

three-fourths of prescriptions for atypical antipsychotics were

initiated after 2000.

Use of antidepressants did not change during the study period, but

55% of benzodiazepines were used during the first half of the study

period.

The authors reported that 181 patients treated with atypical

antipsychotics died during 664.3 person-years of follow-up,

translating into a rate of 27.3 deaths per 100 person-years.

Rates for the other classes of psychotropic medications were 38.8

for conventional antipsychotics, 32.9 for antidepressants, and 40.9

for benzodiazepines, respectively.

Compared with atypical antipsychotics, use of conventional

antipsychotics was associated with a significantly higher adjusted

mortality risk (RR 1.47, 1.14 to 1.91) and increased risk of femur

fractures (RR 1.61, 1.03 to 2.51).

Patients treated with antidepressants had a 20% increased risk of

mortality compared with users of atypical antidepressants (1.20,

0.96 to 1.50) and a 29% increased risk of femur fracture (RR 1.29,

0.86 to 1.94).

Benzodiazepines were associated with a 28% greater mortality risk

compared with atypical antipsychotics (RR 1.28, 1.04 to 1.58) and a

54% increased risk of heart failure (RR 1.54, 0.89 to 2.67).

The authors cautioned that their findings come with all the

limitations of a retrospective, population-based study.

Ascertainment of outcomes other than mortality also lacked

precision, they noted. For example, not taking drugs obtained with

filled prescriptions could lead to erroneous classification.

Additionally, because of limitations in population size and outcome

rates, potential differences among drugs in the same class, or among

different doses of the same drug, could not be examined, further

limiting the findings.

The authors had no relevant disclosures.