Study Finds Haloperidol (Haldol) Poses Risks in Dementia

Haloperidol Moleule Structure
Haldol Use in Dementia. LAGUNA DESIGN/ Getty Images

study published in the online journal BMJ outlines research on antipsychotic medications and their use in people with Alzheimer's and other dementias.

Antipsychotics are a specific type of psychotropic medication that are often used to help control some of the challenging behaviors that people with dementia experience. The initial approach to behaviors should always be to use behavior modification strategies and attempt to determine the causes behind the behaviors, since we know that most behavior has meaning.

However, medications are also prescribed when these non-drug approaches are ineffective.

This particular study reviewed more than 75,000 people in the United States who had been prescribed antipsychotic medications in nursing homes from 2001-2005. (Data from people in nursing homes is easier to collect than for people residing at home; nursing homes are required to report data regularly since they receive funding from Medicare and Medicaid.) Researchers tracked the doses and the type of antipsychotic medication, as well as the mortality rates of those receiving the medications.

The results show that those receiving a specific type of antipsychotic medication called Haldol (haloperidol) have a significantly increased risk of death, especially shortly after treatment is started, compared to other types of antipsychotic medications.

Haldol is a typical antipsychotic, which places it in a classification of an older medication that often has more risks.

Several of the other antipsychotic medications they reviewed were of the atypical class, which is a newer kind of antipsychotic medication that usually has less side effects than the typical ones.

A few thoughts about this study:

  • Having been in the nursing home industry for several years, I can say with confidence that good facilities monitor the use of antipsychotics very closely. These medications have to be periodically reduced, and should not be used without trying non-drug interventions first. Antipsychotic medications also have to be prescribed to treat specific target behaviors that are dangerous for the person or others around them- not just for restlessness or wandering.
    • When research shows a clear risk, as it does here, it highlights your role as an advocate for a family member or friend with dementia. If your loved one is on an antipsychotic, particularly haloperidol, you might consider asking questions about why that drug was chosen, if another medication could be used instead, or if the medication can be decreased or stopped.
    • The risks and benefits of using antipsychotic medications need to be identified and discussed. There are situations where the benefits-- for example, reducing distressing hallucinations and paranoia-- may outweigh the risks of antipsychotics. 

    Sources:

    British Medical Journal. 2012; 344. Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study.  http://www.bmj.com/content/344/bmj.e977​

    Department of Health & Human Services (DHHS). Medicare & Medicaid Services (CMS). Advanced Copy: Dementia Care in Nursing Homes: Clarification to Appendix P State Operations Manual (SOM) and Appendix PP in the SOM for F309 – Quality of Care and F329 – Unnecessary Drugs. May 24, 2013. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-35.pdf

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