• Understand the incidence and risks of tardive
dyskinesia with atypical and conventional antipsychotic therapies in older patients.
metabolic side effects from prescribed antipsychotics therapies in older patients.
• Evaluate potential risks of falls, DM and other
side effects in older patients requiring psycho-active therapies.
– management of psychosis– Brief psychotic disorders due to a general medical
– Management of psychosis– Schizophrenia– Dementia related psychosis– Bipolar disorder– Psychosis related to Parkinson’s disease
• Drug induced movement disorder. • Involuntary choreatic movements that may
appear days and months after the introduction of continuous use of AP1.
• Associated with drugs that block dopamine
receptors (neuroleptics) or central dopaminergic transmission.
– N/V (prochlorperazine)– GI disorders (metoclopramide)
Jesic MP. et al. Med Pregl. 2012.
– 17% - 18% of dementia patients to atypical
Cumulative incidence of definitive TD in
older patients with borderline dyskinesiaa
• Excessive weight gain. • Obesity. • Glucose intolerance. • New-onset type 2 diabetes. • Diabetic ketoacidosis (DKA). • Hypertriglyceridemia. • Death.
• Huybrechts KF. et al. assessed the risk of
mortality associated with the use of individual antipsychotic drugs in elderly residents in nursing homes.
– 75,445 new users; 2001-2005; ≥ 65 y/o; 180 days.
• haloperidol users had an increased risk of mortality.
• Quetiapine users had a decreased risk of mortality.
• Transdermal absorption delayed, especially
• Hepatic drug metabolism may see age related
• Renal elimination typically declines with age.
Cusack BJ. Am J Geriatr Pharmacother. 2004
• Aparasu et al. – community dwelling elderly
– 1996-2004 Medical Expenditure Panel Survey.
– Examined the impact of typical to atypical
– Analytical study sample N=124; mean age 74.37
– Conclusion – typical antipsychotics associated
with increased risk of hospitalizations.
Weight gain Risk for diabetes Worsening lipid profile
+ = increase effect, - = no effect, D = discrpant results. Adapted from: J consensus Development
Conference on Antipsychotic Drugs and Obesity and Diabetes. J Clin Psychiatr. 2004;65:267-272.A14
a = newer drugs with limited long-term data
Jin H. et.al. Schizophrenia Research; 2004
Anticholineric Orthostasis Weight Gain Prolactin
EPS, extrapyramidal side effect; relative side-effect risk: +/-, negligible; =, low; ++, moderate; +++, moderately high; ++++, high.
Crismon L. Argo TR. Buckley PF. Chapter 76 Schizophrenia
• Chatterjee S. et al. evaluated the risk of falls
and fractures associated with the use of risperidone, olanzapine and quetiapine.
– 12, 145; ≥ 50y/o; 2000 – 2008; data from IMS
• Gill SS. et al. – compared the incidence of
admissions to the hospital for stroke in older adults receiving atypical and typical antipsychotics (AP).
– N = 32,710 patients with dementia (17,845 had
been dispensed an atypical AP and 14,865 had been dispensed a typical AP; ≥ 65 y/o; Canadians.
• Jalbert JJ. et al. – study to quantify the
association between AP use and the risk of diabetes onset among NH residents with dementia.
– N = 29,203 long stay Medicaid residents in CA, FL,
Il, NY and Ohio; 1/2001 – 12/2002; ≥ 65 y/o.
– Conclusions – typical AP were associated with an
increase risk of developing diabetes. Atypical AP were not associated with an increase in risk of developing diabetes.
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Olanow CW, Schapira AH. Chapter 372. Parkinson's Disease and Other Movement Disorders. In: Fauci AS, Kasper DL, Jameson JL, Longo DL, Hauser SL, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. http://www.accesspharmacy.com/content.aspx?aID=9146448. Accessed May 7, 2013. http://www.accesspharmacy.com/content.aspx?aID=7987911. Accessed May 7, 2013.
6. Jesić MP. Jesić A. Filipović JB. Zivanović O. Extrapyramidal syndromes caused by
antipsychotics. Med Pregl. 2012 Nov-Dec;65(11-12);521-6.
7. Jin H. Meyer JM. Jeste CV. Atypical antipsychotics and glucose dysregulation.
8. Cusack Bj. Pharmacokinetics in older persons. Am J Geriatri Pharmacother. 2004
9. Crismon L. Argo TR. Buckley PF. Chapter 76 Schizophrenia. In: Talbert RL, DiPiro JT.
Matzke GR. et.al. eds. Pharmacotherapy. 8th ed. NY: McGraw-Hill;2011. http://www.accesspharmacy.com/content.aspx?alD=7987911. Accessed May 7, 2013.
10. Aparasu RR. Jano E. Johnson ML. Chen H. Hospitalization risk associated with
typical and atypical antipsychotic use in community-dwelling elderly patients. Am J Geriatri Pharmacother. 2008 Oct;6(4):198-204.
11. Touré JT. Brandt NJ. Limcanco MR. Briesacher BA. Impact of second-generation
antipsychotics on the use of antiparkison agents in nursing homes and assisted-living facilities. Am J Geriatri Pharmacother.. 2006 Mar;4(1):25-35.
12. Huybrechts FK. Gerhard T. Crystal S. et al. Differential risk of death in older
residents in nursing homes prescribed specific antipsychotic drugs. BMJ. 2012;344:e977.
13. Chatterjee S. Chen H. Johnson ML. Aparasau RR. Risk of falls and fractures in older
adults using atypical antipsychotic agents. Am J Geriatr Pharmacother. 2012;10:83-94.
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