Comparative mortality risks of antipsychotic medications in community-dwelling older adults

Abstract

Significant variation in mortality risk across commonly prescribed antipsychotics suggests that antipsychotic selection and dosing may affect survival of older people living in the community.

High prevalence of psychotropic drug use among persons with and without Alzheimer׳s disease in Finnish nationwide cohort

“…Antipsychotic use has also been associated with an increased risk of death among older persons with and without dementia (Schneider et al, 2005;Wang et al, 2005;Schneeweiss et al, 2007;Ballard et al, 2009;Kales et al, 2012;Gerhard et al, 2014). The risk has been associated with both conventional and atypical antipsychotics but some studies indicate higher risk for conventional antipsychotics compared with atypicals (Wang et al, 2005;Gill et al, 2007;Schneeweiss et al, 2007;Kales et al, 2012;Gerhard et al, 2014).…”

“…The risk has been associated with both conventional and atypical antipsychotics but some studies indicate higher risk for conventional antipsychotics compared with atypicals (Wang et al, 2005;Gill et al, 2007;Schneeweiss et al, 2007;Kales et al, 2012;Gerhard et al, 2014). There may be differences between mortality risks associated with different drug substances (Kales et al, 2012;Gerhard et al, 2014) and there is some evidence of the doseresponse relationship on the risk of death (Gerhard et al, 2014). The risk is pronounced especially at the initiation of treatment (until 180 days) (Wang et al, 2005;Gill et al, 2007;Schneeweiss et al, 2007;Kales et al, 2012;Gerhard et al, 2014).…”

“…There may be differences between mortality risks associated with different drug substances (Kales et al, 2012;Gerhard et al, 2014) and there is some evidence of the doseresponse relationship on the risk of death (Gerhard et al, 2014). The risk is pronounced especially at the initiation of treatment (until 180 days) (Wang et al, 2005;Gill et al, 2007;Schneeweiss et al, 2007;Kales et al, 2012;Gerhard et al, 2014). Sustained risk in long-term use has been reported in some studies (Ballard et al, 2009) whereas other studies have not verified the risk in long-term use (Gardette et al, 2012;Lopez et al, 2013).…”

“…Studies regarding the risk of death associated with psychotropic drug use have been inconclusive. Numerous studies indicate the association between antipsychotic use and an increased mortality risk (Schneider et al, 2005;Wang et al, 2005;Schneeweiss et al, 2007;Ballard et al, 2009;Kales et al, 2012;Gerhard et al, 2014) with some conflicting results (Gardette et al, 2012;Lopez et al, 2013), whereas antidepressant (Ried et al, 2011;Coupland et al, 2011) and benzodiazepine studies (Kripke et al, 1998;Gisev et al, 2011) show mixed results. Antipsychotic and benzodiazepine use has been associated with decline in cognition (Hanlon et al, 1998;Byerly et al, 2001;Paterniti et al, 2002) which counteracts the main goals in the treatment of AD including preservation of cognitive function and delay of institutionalization (Finnish Medical Society Duodecim, 2010).…”

Indications of atypical antipsychotics in the elderly

“…It is particularly noteworthy that olanzapine and risperidone have been shown to increase the risk of death when compared to placebo (number needed to harm = 87), and risperidone is associated with an increased risk of stroke (number needed to harm = 53) [13]. There is an increased risk of death with higher doses of risperidone and olanzapine, and after adjustment for dose, olanzapine and quetiapine have a lower mortality risk than risperidone [19]. Conversely AAPs have been found to decrease mortality following long-term cumulative exposure in their original licensed indication schizophrenia [20] (in an adult rather than elderly population).…”