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August 27, 2014
Acute Kidney Injury Risk Rises with Atypical Antipsychotics
for Dementia Cleveland—Treating older dementia patients with atypical antipsychotic drugs is associated with an increased risk for acute kidney injury (AKI) and other adverse outcomes, according to a new study. The study, led by researchers from Case Western Reserve University School of Medicine in Cleveland and published recently in the Annals of Internal Medicine, notes that millions of older adults are prescribed drugs such as quetiapine, risperidone, and olanzapine to manage behavioral symptoms of dementia even though that is not an approved indication. The off-label use raises safety issues, according to the study, because atypical antipsychotics are linked to AKI. Past research also has shown higher incidence of conditions such as hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis. To determine the risk for AKI and other adverse outcomes, researchers compared medical records for 97,777 adults aged 65 or older in Ontario, Canada, who received a new outpatient prescription for an oral atypical antipsychotic drug to a matched cohort of patients not receiving the prescription. The study period began in 2003 and ended in 2012. Hospitalization with AKI was the primary outcome and was assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels within 90 days of prescription for atypical antipsychotic drugs. Results indicate that atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI (relative risk [RR], 1.73 [95% CI, 1.55 to 1.92]). Use of the drugs also increased risk for hypotension (RR, 1.91 [CI, 1.60 to 2.28]), acute urinary retention (RR, 1.98 [CI, 1.63 to 2.40]), and all-cause mortality (RR, 2.39 [CI, 2.28 to 2.50]). “Atypical antipsychotic drug use is associated with an increased risk for AKI and other adverse outcomes that may explain the observed association with AKI,” the authors conclude. “The findings support current safety concerns about the use of these drugs in older adults.” |
U.S. Pharmacist Social Connect
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