Antipsychotic Drugs — Overused Heart Attack Risk for Elderly Patients

The “antipsychotic” class of drugs is distributed liberally in nursing homes.

Antipsychotics including Risperdal, Seroquel, Zyprexa, and Abilify, are frequently given to the elderly who are suffering from dementia so they are easier to control. It’s a handy tool in a nursing home that is understaffed and needs to find a form of ‘chemical restraint’ when dementia patients are aggressive, anxious, or acting out.

However, this study reports that these popular drugs appear to increase the risk of a heart attack in older individuals.

French researchers noticed a spike in heart attacks among Canadian elderly in nursing homes who were prescribed antipsychotics. Looking back in a retrospective cohort study of 11,000 elderly patients between the years 2000 to 2009, there was a 30 percent jump in heart attacks within the first year after taking atypical antipsychotics, as this newer class of antipsychotics are known, when compared to non-medicated patients.  The first month had the highest risk of a heart attack, when the risk more than doubled. After that, the risk seemed to decrease.

The patients were also taking cholinesterase inhibitors for dementia.

This study, published in the Archives of Internal Medicine on March 26, 2012, specifically looked at the use of antipsychotic agents with the risk of acute myocardial infarction (MI). Previously these drugs had been associated with a risk of ischemic stroke in the elderly population.

Antipsychotics are prescribed to treat bipolar disorder and schizophrenia. Given to patients suffering from dementia is considered ‘off-label’ use because the U.S. Food and Drug Administration (FDA) had not approved the drug for that use. Drugmakers cannot legally promote the drug for uses not on the label.

When the federal government looked into atypical antipsychotics last May, the agency found this sort of dangerous dispensing was widespread with 83 percent of the drugs given ‘off-label.’ Back in 2005, the FDA was so concerned that it added a black box warning, a strong advisory, against using atypical antipsychotics in this way.

What’s shocking is that the prescriptions of these antipsychotic drugs has doubled in the last ten years to about 9 million prescriptions annually. What’s accounting for these many users? Doctors will prescribe this new and improved generation of antipsychotic drugs to help people sleep, for attention deficit disorder, for anxiety and behavior problems in toddlers.

That has been very good for the bottom line with the antipsychotic drug industry totaling about $16 billion in sales in 2010, according to a health care monitoring firm.

As the full safety picture of these controversial drugs is just being understood, that is not stopping the drug companies from aggressive marketing and hype. Lawsuits such as the 2009 case against Eli Lilly and Co., which had to pay the federal government $1.4 billion to settle charges it illegally marketed Zypreza to nursing homes, has not slowed the trend.

Even an FDA warning that antipsychotics should not be used in the treatment of dementia-related psychosis has not slowed the trend of using atypical antipsychotics on our elderly in nursing homes putting their fragile health in further jeopardy.