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Antipsychotic Drugs Endanger Elderly With Dementia, Inspector General Says

Doctors are routinely prescribing powerful antipsychotic drugs to treat elderly nursing home patients with dementia, despite warnings that those drugs could be lethal for them, a government watchdog says.

The Food and Drug Administration has approved antipsychotic drugs such as Risperdal and Seroquel for the treatment of such serious mental disorders as schizophrenia and bipolar disorder. But in a new audit, the Department of Health and Human Services’ inspector general says 14 percent — or one in seven — of elderly nursing home patients were prescribed the drugs.

Of those, 88 percent of the prescriptions were for patients with dementia — for whom the drugs can be deadly. “These results are alarming,” Sen. Charles E. Grassley R-Iowa, who requested the audit, told The New York Times. “Medicare officials need to pay attention.”

Prescriptions for off-label uses of antipsychotic drugs — uses other than those approved by the FDA — cost the Medicare program $116 million in the first six months of 2007, the audit found.

In 2005 the FDA gave this class of drugs its most severe warning, noting the increased risk of sudden death in patients with dementia. Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report newsletter, told the Times that doctors continue to prescribe them for dementia because they have few other good choices for dealing with some behavioral problems associated with dementia.

“Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Carlat said.

The federal audit focused exclusively on “atypical” antipsychotics, which differ chemically from, and have different side effects than, older antipsychotic medications such as Haldol and Thorazine.

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