Need for Higher Regulation of SGA Prescribing for BPSD

Need for Higher Regulation of Second Generation

Antipsychotics Prescribing for Behavioral & Psychological

Symptoms of DementiaCaitlyn Cardetti

Advisor: Dr. Dawn Albertson

The Elderly• Fastest growing age group.• Often excluded from clinical trials.• Most likely age group to use

prescription drugs.

1 2 3-4 5+

Risk of Polypharmacy with AgeAges 20-59 Age 60+

Number of Prescription Drugs

The Aging Body & Drugs

Behavioral & Psychological Symptoms of Dementia (BPSD)

• Symptoms include but are not limited to:• Agitation• Irritability• Anxiety

• Commonly treated with off label use of second generation antipsychotics (SGA)• FGA vs. SGA

Purpose• Identify appropriateness of SGA as treatment for BPSD• Efficacy• Possible Adverse Drug Effects (ADE)

• Specific issues concerning the elderly• Exacerbation of Age-Associated Diseases• Drug Interactions

Methodology• Use of broad search terms in PubMed database• Preliminary search found only 3 of 9 SGA to be

effective for treatment of BPSD• Olanzapine• Risperidone• Aripiprazole

• Each drug individually searched inwith the following categories:• Adverse Drug Effects (ADE)• Age-Associated Diseases• Polypharmacy

Exacerbation of Age-Associated Diseases• Cardiovascular Disease• Olanzapine – favorable QTc profile• Risperidone – increased risk of stroke, possible risk of QT

prolongation• Aripiprazole – possible risk of QT prolongation

• Diabetes• Olanzapine – associated with increased glucose levels• Risperidone – associated with a few cases of

hyperglycemia• Aripiprazole – no data

Drug Interactions• Donezepil (Aricept)• Treatment for mild to moderate Alzheimer’s Disease• Possible indication of increased movement disorders with

olanzapine

• Antidiuretics• Drugs that limit formation of urine• No literature available

• Beta Blockers• Drugs commonly prescribed for HTN• Olanzapine is inhibited by a common beta blocker

• Statins• Medication that lowers cholesterol• Possible increased risk of muscle breakdown

when used with SGA

114%

214%

3-431%

5+42%

Polypharmacy in those Age 60+

Conclusion & Recommendations• Increase resources available for doctors when

prescribing• Need for further studies in exacerbation of age-associated

diseases and drug interactions

Olanzapine

Risperidone

Aripiprazole

Donezepil - ? ?Antidiuretics

? ? ?Beta Blockers

- ? ?Statins - - -

Olanzapine

Risperidone

Aripiprazole

CV Disease

+ - -/?Diabetes - - ?

Conclusions & Recommendations• Update the Beers Criteria

Conclusions & Recommendations• Update the Beers Criteria

Conclusions & Recommendations• Create standard guidelines for prescribing• Assurance that non-pharmacological interventions were

tried but failed• Evaluations for drug profiles based on patient’s current

health condition• Recommendations for follow-ups

References• Cerejeira, J., Largarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological

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Shekelle, P.G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: A systematic review and meta-analysis. Journal of American Medical Association, 306(12), 1359-69. Retrieved from http://www.ncbi.nlm.nih.gov.ezproxy.mnsu.edu/pubmed/21954480

• Department of Health and Human Services, Administration of Aging. (2011). Aging statistics. Retrieved from website: http://www.aoa.gov/AoARoot/Aging_Statistics/index.aspx

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• Agency for Healthcare Research and Quality, Effective Health Care Program. (2011). Off-label use of atypical antipsychotics: An update. comparative effectiveness review no. 43 (Publication No. 11-EHC087-EF). Retrieved from AHRQ Publication website: http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=786

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