Older adults treated with atypical antipsychotics are at increased risk of kidney injury, according to a study published today in the Annals of Internal Medicine. The findings add to previous evidence that this class of drugs is risky for older adults.
Although atypical antipsychotics are commonly prescribed for older adults to treat agitation and other behavioral symptoms of dementia, the US Food and Drug Administration has not approved the drug for this purpose. In fact, since 2005 the agency has warned that use of these drugs to treat older adults with dementia was associated with a 2-fold increased risk of death. An agency analysis of 17 placebo-controlled trials found the risk of death among patients with dementia taking olanzapine, aripiprazole, risperidone, or quetiapine was 4.5% compared with 2.6% among those taking a placebo.
Use of atypical antipsychotics is associated with a range of adverse effects, including hypotension, pneumonia, heart attack, and the breakdown of muscle tissue, that may contribute to kidney injury. But the extent of the potential kidney risk was unclear, so Y. Joseph Hwang, MSc, of the London Health Sciences Centre in Ontario, Canada, and colleagues conducted a cohort study comparing 97 777 patients aged 65 years or older receiving a new atypical antipsychotic prescription with 97 777 matched controls to assess the risk of kidney injury within 90 days. Patients who received an atypical antipsychotic medication were more likely to be hospitalized with a kidney injury. Use of the medication was also associated with low blood pressure, urine retention, and death.
In addition, the researchers looked at a subgroup of patients with creatinine levels available (a measure of kidney function). They found the absolute risk of hospitalization for kidney injury was about 2% higher in the treated group (5.46% vs 3.34%).
The authors conclude that the study adds to evidence that use of atypical antipsychotics in elderly patients should not be taken lightly.
“The drugs should be used only after other approaches have been exhausted; when prescribed, patients must warned about potential adverse events,” they wrote.
They recommend careful monitoring of blood pressure, creatinine levels, and other potential signs of kidney problems in older patients receiving atypical antipsychotics. Physicians treating older patients with kidney injury should consider these medications a potential cause and stop use of the drugs if possible, they wrote.