Since 2008, antipsychotic drugs new and old have carried a black-box warning about death risk in dementia patients. But a new study shows that the risk isn't monolithic. It varies significantly from drug to drug, and it increases at higher doses, researchers found.
Published in the British Medical Journal, the study looked at more than 75,000 dementia patients who were given antipsychotic drugs. The Harvard Medical School researchers followed the patients for 6 months from their initiation of antipsychotic therapy, and they concluded that mortality risk was highest among patients using an older drug, haloperidol, also known by its brand name, Haldol.
Haloperidol patients appeared twice as likely to die as those using risperidone, the generic version of Johnson & Johnson's ($JNJ) newer, atypical antipsychotic Risperdal, The Wall Street Journal notes. Patients on quetiapine, sold by AstraZeneca ($AZN) under the brand name Seroquel, were significantly less likely to die than risperidone patients were, the researchers concluded. Other atypicals' risks weren't significantly different from risperidone's.
What's more, the death risk appeared greatest in patients on the highest doses, and appeared to increase as dosage increased. "The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine," the study concluded. The upshot, according to the study? Antipsychotics should not be used in dementia patients "in the absence of clear need."
Health officials in Britain said that the study showed the drugs should only be used in dementia patients when there's no other alternative. And they suggested that use be limited to the short term--up to 12 weeks. Non-drug interventions should be tried first, experts told the WSJ.