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Antipsychotics Still Widely Used in U.S. Nursing Homes
Date:1/11/2010

Off-label use to control behavior seems to be part of the 'culture' at some centers, one study finds

MONDAY, Jan. 11 (HealthDay News) -- Many Americans in nursing homes still get powerful antipsychotic medications, despite recent attempts by the U.S. government to rein in the practice, two new studies show.

The practice can control problem behaviors, but can also threaten physical health. Since the U.S. Food and Drug Administration instituted a "black box" warning in 2005, one study found a 19 percent decrease in the prescription of atypical antipsychotics in elderly people with dementia. But the researchers found that in 2008, antipsychotics still represented 9 percent of all prescriptions in this group.

"The [2005] safety warning pertained to an increased risk of death among individuals using these drugs, so the public health ramifications of use of these drugs in elderly people with dementia, often in nursing homes, which we consider a vulnerable population, is concerning," said Dr. E. Ray Dorsey, an assistant professor of neurology at the University of Rochester Medical Center and lead author of one of the studies in the Jan. 11 issue of the Archives of Internal Medicine.

Antipsychotics, developed to treat psychiatric conditions such as bipolar disorder and schizophrenia, are widely used "off label" to control difficult behavior in elderly people with dementia.

Indeed, Dorsey said he suspects that the vast majority of the use documented in his research is "off label."

In the United States, no antipsychotics are approved to calm behavior, although one such drug, risperidone (Risperdal), is approved for that indication in Canada. Black box warnings are rare for off-label use.

"There's a real disconnect between the evidence and the prescribing patterns," said Becky A. Briesacher, co-author of the second study, also in the Jan. 11 issue of Archives, and an associate prof
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