Government and Regulations

Off-Label Use of Antipsychotics for Dementia Patients Discouraged


Hospitalists can play a major role in reducing deaths that come as a result of off-label prescriptions for antipsychotic drugs being given to dementia patients, according to the Centers for Medicare & Medicaid Services (CMS) and SHM.

In a letter to hospitalist leaders, SHM encouraged hospitalists to “partner with others in your clinical work environment to reduce the use of antipsychotics for treating behavioral problems in patients with dementia. We believe that hospitalists have an important role to play in this initiative; hospital-based clinicians frequently care for patients with dementia and are responsible for medications prescribed during a patient’s hospitalization and at discharge.”

The joint education effort by CMS and SHM is based on an April 2011 report from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) that found that antipsychotic medications sometimes are used to treat patients with dementia for off-label reasons (e.g. “behaviors”) or against black-box warnings despite potential dangers to patients’ health.

An earlier warning from the FDA in 2008 outlined the potential dangers as:

  • Increased risk (60% to 70%) of death in older adults with dementia;
  • Prolongation of the QT interval on electrocardiogram, particularly with intravenous haloperidol use;
  • Increased risk of stroke and TIAs; and
  • Worsening cognitive function.

The letter to hospitalists noted the necessary changes and the need for collaboration between SHM, its members, and hospital leaders. “Increased prescriber training and system practice changes will help reduce unnecessary antipsychotic drug prescribing,” the letter stated. “SHM looks forward to an ongoing collaboration with members and hospital leaders on this important patient safety concern.”

Recommendations for Appropriate Use of Antipsychotics and Dementia

  • Work to ensure that appropriate, short-term use of antipsychotics for dementia-related psychosis not be followed by inappropriate long-term use at the time of discharge.
  • Work with hospital administration and quality-improvement (QI) teams to incorporate order sets that use lower, safer doses of conventional or atypical antipsychotics paired with appropriate assessment and monitoring.
  • Collaborate with other providers to create a systems-level approach to monitor and track antipsychotic use in the hospital and at discharge.
  • Ensure that patients and caregivers are consistently informed of the risks related to antipsychotics.
  • Educate about and put into practice the use of alternative strategies for managing behavioral problems in patients with dementia, as appropriate.

Source: Centers for Medicare & Medicaid Services

Next Article:

   Comments ()