Nursing Home Residents Receiving Too Many Antipsychotics

We have long been following and written about the dangerous problem of the needless dosing of the elderly with antidepressants, antipsychotics, and sedatives. These drugs are sometimes given for seemingly pointless reasons and, on occasion, appear to be linked to falls and other accidents in the elderly, including death.

Now, government auditors report that <"">antipsychotic overuse by nursing homes places these senior patients at risk, wrote FiercePharma, which pointed out that about one in seven nursing home residents are treated with atypical antipsychotics. The drugs are not approved by the U.S. Food and Drug Administration (FDA) for dementia treatment and do contain an FDA warning that use of these medications in elderly populations can put this demographic at risk, said FiercePharma.

According to FiercePharma, over half of all antipsychotic prescriptions paid by Medicare in the first two quarters of 2007 were “erroneous,” said the Health and Human Services Inspector General. The errors cost Medicare, which is funded by the federal government, $116 million.

The Center for Medicare and Medicaid Services says the overuse of antipsychotics is due, in part, to drug manufacturers touting atypical antipsychotics for off-label uses, even paying out physician kickbacks, noted FiercePharma. Prescriptions can be written at physician discretion for off-label uses; however, it is illegal for drug makers to advertise or market medications for uses that are not FDA approved.

FiercePharma, citing the New York Times, noted that Omnicare, a nursing home pharmacy firm, paid $98 million in 2009 to settle claims it accepted kickbacks from Johnson & Johnson and other drug manufacturers to increase prescriptions for antipsychotic drugs. As a matter-of-fact, said FiercePharma, drug makers paid more than $1 billion to settle off-label marketing investigations over off-label antipsychotic marketing: Eli Lilly: $1.4 billion over Zyprexa; Bristol-Myers Squibb: $515 million over Abilify; AstraZeneca: $520 million over Seroquel; and Pfizer: $2.3 billion over how marketed drugs including Geodon.

Atypical antipsychotics are known to be used off label to control some undesirable reactions in the elderly, such as agitation, aggression, and hallucinations, specifically in patients diagnosed with Alzheimer’s disease and dementia. There are no drugs currently approved by the FDA to manage these behavioral issues; however, medications often used off label include Abilify (generic: aripiprazole), Zyprexa (generic: olanzapine), Seroquel (generic: quetiapine), and Risperdal (generic: risperidone). Risks include diabetes, movement disorders that can become permanent, pneumonia, stroke, weight gain, and sudden cardiac death.

A review by the American Society of Health-System Pharmacists (ASHP) reports that inappropriate use of antipsychotics remains high in the nursing home resident community, said Consumer Reports previously. This, over five years after the FDA issued a warning against using these drugs in nursing home populations due to significant health threats, including death.

Also, in a study published in the 2010 Archives of Internal Medicine, researchers found that antipsychotics were typically initiated in a patient’s first week at a nursing home, suggesting that behavioral interventions—the first treatment of choice—was not used or was used very infrequently, reported Consumer Reports.

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