A comparison of risperidone and haloperidol for the risk of ischemic stroke in the elderly: a propensity score-matched cohort analysis

Shin, Ju Young; Choi, Nam-Kyong; Lee, Joongyub; Park, Mi Ju; Lee, Shin Haeng; Park, Byung Joo

doi:10.1177/0269881115578162

Cited by 11 publications

(6 citation statements)

References 35 publications

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“…There are other mechanisms than interference with cardiac repolarization and development of TdP which may be of importance to explain the elevated ‘baseline risk’ for death among users of antipsychotics. These include indirect effects on metabolism and weight gain, other cardiovascular effects such as hypertension or alterations in heart rate variability, increased risk for stroke, as well as increased risk to die in cardiovascular disease by nature of their illness . Furthermore, the lack of TdP classification cannot conclude that these medicines confer no risk in relation to development of TdP arrhythmia .…”

Section: Discussionmentioning

confidence: 99%

Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Danielsson¹,

Collin²,

Bergman³

et al. 2016

Brit J Clinical Pharma

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AIMThe aim of the study was to examine mortality risk associated with use of antidepressants and antipsychotics classified with torsades de pointes (TdP) risk in elderly. METHODSA matched case-control register study was conducted in people 65 years and older dying outside hospital from 2008-2013 (n = 286 092) and matched controls (n = 1 430 460). The association between prescription of antidepressants and antipsychotics with various TdP risk according to CredibleMeds (www.crediblemeds.org) and all-cause mortality was studied by multivariate conditional logistic regression adjusted for comorbidity and several other confounders. RESULTSUse of antidepressants classified with known or possible TdP risk, was associated with higher adjusted risk for mortality (OR 1.53, 95% CI 1.51, 1.56 and OR 1.63, 95% CI 1.61, 1.67, respectively) compared with antidepressants classified with conditional TdP risk (OR 1.25, 95% CI 1.22, 1.28) or without TdP classification (OR 0.99, 95% CI 0.94, 1.05). Antipsychotics classified with known TdP risk were associated with higher risk (OR 4.57, 95% CI 4.37, 4.78) than antipsychotics with possible risk (OR 2.58, 95% CI 2.52, 2.64) or without TdP classification (OR 2.14, 95% CI 2.03, 2.65). The following risk ranking was observed for commonly used antidepressants: mirtazapine > citalopram > sertraline > amitriptyline and for antipsychotics: haloperidol > risperidone >olanzapine > quetiapine. CONCLUSIONThe CredibleMeds system predicted drug-associated risk for mortality in the elderly at the risk class level. Among antipsychotics, haloperidol, and among antidepressants, mirtazapine and citalopram, were associated with the highest risks. The results suggest that the TdP risk with

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Section: Discussionmentioning

confidence: 99%

Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Danielsson¹,

Collin²,

Bergman³

et al. 2016

Brit J Clinical Pharma

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“…Indeed, some studies suggest a greater risk of stroke among users of first-generation antipsychotics as compared with second-generation antipsychotics [10,12]. Shin et al reported that among elderly patients, haloperidol, a first-generation antipsychotic, was associated with a greater risk of stroke as compared with risperidone, a second-generation antipsychotic [13]. However, other studies have suggested a similar risk between first-generation and second-generation antipsychotics [7,12,14] or a greater risk with second-generation antipsychotics [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…Though strokes are more common among elderly individuals than among the young individuals [17], more than half of antipsychotic users are < 65 years old [18,19] and though many studies evaluating antipsychotics and the risk of stroke have been conducted in the elderly population [13,[20][21][22], relatively few have been conducted in younger populations. Mundet-Tuduri et al [8] reported a higher prevalence of stroke in adult patients using antipsychotics compared with non-users (odds ratio 2.33).…”

Section: Introductionmentioning

confidence: 99%

Stroke Risk Among Non-Elderly Users of Haloperidol or First-Generation Antipsychotics vs Second-Generation Antipsychotics: A Cohort Study from a US Health Insurance Claims Database

Fife

Blacketer

Knight

et al. 2021

Drugs - Real World Outcomes

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Background Previous studies have reported an increased risk of stroke in patients taking antipsychotics. However, most of these studies have been conducted in the elderly population. Objective We estimated stroke risk in new users of any first-generation antipsychotic or haloperidol, vs second-generation antipsychotics among patients aged 18-64 years without a recent dementia diagnosis and, separately, regardless of a recent dementia diagnosis. Methods Data were obtained from IBM MarketScan ® Commercial Database (1 January, 2001-31 December, 2017. Among new users without a recent dementia diagnosis, stroke risk for first-generation antipsychotics (FGAw/oD cohort) or haloperidol (HALw/oD cohort) was compared with second-generation antipsychotics (SGAw/oD cohort). A similar comparison was conducted among new users regardless of dementia diagnosis: first-generation antipsychotics (FGA cohort) or haloperidol (HAL cohort) vs second-generation antipsychotics (SGA cohort). Crude incident stroke rates within each cohort were determined. For hazard ratios, three propensity score matching strategies were used: unadjusted (crude), Sentinel propensity score strategy, and large-scale regularized regression model (adapted propensity score strategy). Results Each cohort included ≥12,000 patients. The incident rates for stroke per 1000 person-years were 3.10 (FGAw/oD), 5.99 (HALw/oD), 0.85 (SGAw/oD), 3.14 (FGA), 6.12 (HAL), and 0.90 (SGA). Pre-planned analysis with adapted propensity score strategy matching yielded calibrated hazard ratios for stroke: FGAw/oD vs SGAw/oD: 2.05 (calibrated confidence interval 1.13-3.89); HALw/oD vs SGAw/oD: 2.47 (1.14-5.48), FGA vs SGA: 1.64 (0.94-2.97), and HAL vs SGA: 1.98 (0.99-4.00). A post-hoc sensitivity analysis to address potential bias introduced by the 2015 change from the International Classification of Diseases, Ninth Revision to the International Classification of Diseases, Tenth Revision yielded calibrated hazard ratios for FGAw/oD vs SGAw/oD: 1.59 (0.87-3.01), HALw/oD vs SGAw/oD: 2.79 (1.24-6.42), FGA vs SGA: 1.41 (0.79-2.62), and HAL vs SGA: 3.47 (1.63-7.92). Conclusions Among adults aged ≤64 years, without a recent dementia diagnosis, stroke risk is higher among those exposed to haloperidol compared with those exposed to second-generation antipsychotics.

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“…10 Another study in older adults found an increased risk of stroke with haloperidol users compared with risperidone users. 11 Risperidone is commonly prescribed for the management of delirium symptoms in older hospitalized patients and the second most studied agent. 9,12 This pilot study aimed to evaluate the feasibility of a randomized placebo controlled trial to evaluate the efficacy and safety of risperidone in the treatment of delirium.…”

mentioning

confidence: 99%

“…A cohort study observed a small increased risk of mortality with haloperidol compared with atypical antipsychotics 10 . Another study in older adults found an increased risk of stroke with haloperidol users compared with risperidone users 11 . Risperidone is commonly prescribed for the management of delirium symptoms in older hospitalized patients and the second most studied agent 9,12 …”

mentioning

confidence: 99%

Efficacy and Safety of Risperidone in Patients With Delirium

Nguyen,

2023

J Clin Psychopharmacol

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Background The cornerstone treatment of delirium is to assess and treat its underlying causes and prevent further complications. Drug therapy may be necessary to control agitation and behavioral symptoms associated with delirium. The aim of this pilot study was to evaluate the feasibility of a randomized placebo controlled trial to evaluate the efficacy and safety of risperidone in the treatment of delirium. Methods This was a randomized double-blinded placebo-controlled trial. Patients were enrolled in the study if they were hospitalized and 65 years or older and had a diagnosis of delirium. Delirium Rating Scale revised 98 was used to determine delirium and motor agitation. Results A total of 14 participants with 57% being men and having a mean age of 86 years were included. There were no statistically significant differences between the risperidone and placebo group for the Delirium Rating Scale revised 98 score. There were no severe adverse reactions reported in the study, and no patients discontinued the study for adverse reactions. Conclusions Risperidone at low doses (1 mg daily or less) was well tolerated for the treatment of delirium. Future large-scale trials are needed to evaluate the safety and efficacy of risperidone in the treatment of delirium. This pilot study taught us that the phase 2 RIsperDone DELirium trial will need a multicenter design with more research personnel to increase the number of participants enrolled.

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A comparison of risperidone and haloperidol for the risk of ischemic stroke in the elderly: a propensity score-matched cohort analysis

Abstract: The evidence showed that haloperidol should be prescribed in the elderly with caution.

Cited by 11 publications

References 35 publications

Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Stroke Risk Among Non-Elderly Users of Haloperidol or First-Generation Antipsychotics vs Second-Generation Antipsychotics: A Cohort Study from a US Health Insurance Claims Database

Efficacy and Safety of Risperidone in Patients With Delirium

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