I’m not real sure why this was making headlines yesterday, but apparently the fact that the FDA required a black box warning on older antipsychotic medications was news on a slow news day. Here’s why it wasn’t news:

  • Both conventional antipsychotics and atypical antipsychotics are not approved for use in elderly patients with dementia.
  • The risk of death for atypical antipsychotics in this patient group is 3.2 times more likely, and is 1.7 times more likely for those taking conventional antipsychotics. In other words, conventional antipsychotics are still nearly twice as safe and carry half the risk of an atypical antipsychotic.
  • Atypical antipsychotics typically have a different side effect profile than conventional antipsychotics. Many news reports parroted the marketing literature by suggesting atypicals have fewer side effects.
  • Prescribing any type of medication to seniors greater than 80 years of age and already in a nursing home who are often dealing with cancer or other serious medical illnesses carries a much greater risk than prescribing the same medication to younger, healthier adults. This is news?

I doubt additional black box warnings will stop physicians prescribing this class of drugs to seniors in nursing homes, because it helps the staff manage them (e.g. warehousing is easier). Antipsychotic prescriptions to seniors with a history of heart attack, heart problems or pneumonia are especially concerning.

If, however, you have a family member in a nursing home, check with their physician to see what kinds of medications your family member is taking. Raise questions if they are being prescribed either kind of antipsychotic medication (especially if your family member has a history of heart problems, a heart attack, or previous bouths of pneumonia), and ask to speak to his or her physician. Some questions to consider:

  • Why are you prescribing an antipsychotic?
  • What specific symptoms are you trying to manage?
  • Are there other options available to help manage these symptoms?
  • What dose is he/she being prescribed? Can this be lowered?

Antipsychotic medications should never be used as a substitute for proper, non-medical management of dementia in the elderly. Of course, that usually means more staffing, which most nursing homes are loathe to invest in.

Read the full article: FDA Orders Warning Label on Older Antipsychotics