Research illustrates concerns over antipsychotic drugs
By Paul Mayne
August 19, 2014
New Western-led research shows patients who are prescribed a popular class of antipsychotic drugs to temper dementia are at a higher risk for acute kidney injury than patients who are not prescribed these drugs.
Schulich School of Medicine & Dentistry professor Dr. Amit Garg said the drugs, called atypical or second-generation antipsychotics, are used to manage behavioural symptoms of dementia.
“The U.S. Food and Drug Administration warns of increased risk for death in older patients treated with these drugs, but studies are limited,” said Garg, lead author and kidney specialist at Lawson Health Research Institute. “Though not an approved indication, these drugs are frequently used to manage behavioural symptoms of dementia. This use has raised safety concerns.”
Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults - A Population-Based Cohort Study was published in the August issue of the Annals of Internal Medicine. Y. Joseph Hwang, the first author on the paper, did his MSc thesis in Epidemiology and Biostatistics in 2013 on this topic under Garg's supervision.
Adverse outcomes associated with these drugs, such as low blood pressure, acute urinary retention and the breakdown of muscle tissue, are known to cause acute kidney injury. Moreover, pneumonia, heart attacks and dangerous heart rhythm disturbances have also been associated with use of these drugs.
For these reasons, researchers did a population-based study of older adults to investigate the 90-day risk of hospitalization with acute kidney injury and other adverse outcomes from new use of the drug. They looked at almost 100,000 patients 65 years and older who either were prescribed quetiapine, risperidone or olanzapine and followed the outcomes of these patients for 90 days after the date of the original prescription.
The comparison group was another 100,000 patients who were similar in their baseline health as the antipsychotic drug users but who were not prescribed the drug.
“The results of this study calls for a careful reevaluation of prescribing atypical antipsychotic drugs in older adults, especially for the unapproved indication of managing behavioural symptoms of dementia,” Garg said. “The drugs should be used after other approaches have been exhausted; and when prescribed, patients must be warned about potential adverse effects.”
The research was with the help of the Institute for Clinical Evaluative Sciences, an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health-care issues.
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