Antipsychotics Still Used for Parkinson’s Despite Risks

Despite black box warnings—the strongest the U.S. Food and Drug Administration (FDA) places on medications—physicians continue to prescribe <"">antipsychotic medications such as Risperdal (risperidone) and Zyprexa (olanzapine) for their patients with Parkinson’s disease. The drugs have been linked to higher risks of death in patients with dementia, noted WebMD, a common comorbidity in those with Parkinson’s.

“My sense is that the black box warnings don’t factor into decision making,” said study researcher Daniel Weintraub, MD, an associate professor of psychiatry at the University of Pennsylvania, quoted WebMD. The study is published in the Archives of Neurology.

The black box warns that the medications are linked with increased risks of fatalities for people suffering from dementia; as a matter-of-fact, some of the more common antipsychotics can intensity Parkinson’s disease symptoms, noted WebMD.

About 60 percent of those with Parkinson’s will experience some type of psychosis, according to the recent study, said WebMD. Weintraub and his team, found that about half of those Parkinson’s patients with psychosis were treated with antipsychotics.

Risperdal and Zyprexa have not been proven efficacious in the treatment of Parkinson’s; however, about 30 percent of those with Parkinson’s and psychosis take these drugs while Clozaril (clozapine), the only drug proven effective and well-tolerated in the treatment of psychosis in those with Parkinson’s is only prescribed to about 2 percent of those patients, said WebMD.

“The gold standard treatment is also one of the most impractical treatments,” said neurologist Hubert Fernandez, MD, a Parkinson’s specialist at the Cleveland Clinic’s Center for Neurological Restoration, quoted WebMD. But, Clozapine is not perfect and comes with a rare and sometimes fatal side effect that requires patients have blood levels regularly checked. Because of this, physicians tend to shy away from the drug.

Other alternatives don’t offer meaningful solutions. For instance, Abilify (aripiprazole), is not well tolerated by Parkinson’s patients and Seroquel’s (quetiapine) efficacy has not been proven despite three studies. “Quetiapine is the No. 1 choice without clear evidence that it’s effective,” said Weintraub. In other words, although the least effective in a number of studies, Seroquel is routinely prescribed to Parkinson’s patients.

Seroquel was introduced in 1997 to treat psychotic disorders, schizophrenia, and bipolar disorder. In recent years, AstraZeneca has faced over 9,000 Seroquel lawsuits filed by people who claim the company withheld information about the antipsychotic drug’s diabetes risk. Also, earlier this year we reported that U.S. health regulators ordered cautions be added to ALL antipsychotic drug labels regarding their risk of abnormal muscle movements (extrapyramidal symptoms or EPS) and withdrawal syndromes in newborns when used in pregnancy. The new cautions will apply to older and new generation antipsychotics, including Haldol, FazaClo, Fanapt, Clozaril, Risperdal, Zyprexa, Seroquel, Abilify, Geodon, Invega, Loxitane, Moban, Navane, Orap, Saphris, Stelazine, Thorazine, and Symbyax, according to an FDA alert.

Atypical antipsychotics, like Seroquel, are favored by many doctors and patients because they carry a decreased risk of side effects related to loss of motor control, a major problem with older “typical” antipsychotics. But Seroquel and similar drugs carry other safety risks, such as increased risks for weight gain and diabetes. In 2003, the FDA required the makers of atypical antipsychotics to re-label them to include warnings regarding their risk of hyperglycemia and diabetes mellitus. In 2005, the FDA also warned that such drugs increased the risk of death among elderly people.

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