Sensitivity to Antipsychotic Drugs in Older Adults
- 554 Downloads
Antipsychotic medications are widely used to manage psychotic and behavioral disorders in older adults, including primary psychotic disorders such as schizophrenia, and psychosis and behavioral disturbances associated with dementia. These two broad diagnostic indications are associated with contrasting recommended treatment durations, with the former requiring indefinite treatment across the life span. Antipsychotic drug dosing for schizophrenia is based primarily on studies of younger patients and thus may not apply to older adults. It is critically important to address the effects of aging on antipsychotic dosing given the recent emergence of data that suggest a critical role for age-related sensitivity to these drugs. Antipsychotic drugs are not only associated with somatic and neurological adverse effects but also increased all-cause mortality and sudden cardiac death in this vulnerable population. This review focuses on the sensitivity of older adults to adverse effects from antipsychotic medications and the current pharmacokinetic and pharmacodynamic explanatory models of susceptibility. Implications of recent research findings for individualized pharmacotherapy are discussed.
KeywordsAntipsychotic drugs Aging Schizophrenia
Dr. Suzuki’s fellowship has been supported by the Japanese Society of Clinical Psychopharmacology, the Government of Canada Post-Doctoral Research Fellowships, the Kanae Foundation, and the Mochida Memorial Foundation.
Dr. Uchida has received grants, speaker honoraria, and/or manuscript fees from Dainippon Sumitomo Pharma, Janssen Pharmaceutica, Pfizer, and Otsuka Pharmaceutical Group.
Dr. Mamo is the recipient of an investigator-initiated grant from Pfizer. No other potential conflicts of interest relevant to this article were reported.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.•• Ray WA, Chung CP, Murray KT, et al.: Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009, 360:225–235. (Published erratum appears in N Engl J Med 2009, 361:1814). This retrospective cohort study found that current users of typical and atypical antipsychotic drugs had a similar dose-related increased risk of sudden cardiac death.CrossRefPubMedGoogle Scholar
- 9.Alexopoulos GS, Jeste DV, Chung H, et al.: The expert consensus guideline series. Treatment of dementia and its behavioral disturbances. Introduction: methods, commentary, and summary. Postgrad Med 2005, Jan:6–22.Google Scholar
- 11.• Uchida H, Mamo DC: Dosing of antipsychotics in schizophrenia across the life-spectrum. Prog Neuropsychopharmacol Biol Psychiatry 2009, 33:917–920. This is a review of antipsychotic dosing principles in older adults and current theories regarding increased drug sensitivity in this population.CrossRefPubMedGoogle Scholar
- 13.Jeste DV, Barak Y, Madhusoodanan S, et al.: International multisite double-blind trial of the atypical antipsychotics risperidone and olanzapine in 175 elderly patients with chronic schizophrenia. Am J Geriatr Psychiatry 2003, 11:638–647. (Published erratum appears in Am J Geriatr Psychiatry 2004, 12:49).PubMedGoogle Scholar
- 30.Davidson M, Galderisi S, Weiser M, et al.: Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST). Am J Psychiatry 2009, 166:675–682. (Published erratum appears in Am J Psychiatry 2009, 166:731.)CrossRefPubMedGoogle Scholar