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Medical Forum / General / General / January 2006Risperdal vs. Lorazetam(sp?)
Anyone have experience with the effects of either on helping eldery patients with dementia to sleep? In this case, 1/2mg of Lorazatam(sp?) helps a little, but 1mg puts the patient into a drunken-like state of mind and gives more problems sleeping than with no medication. Haven't tried risperdal yet, but the prescription is for 1/2 to 1 mg. John > Anyone have experience with the effects of either on helping eldery patients > with dementia to sleep? [quoted text clipped - 6 lines] > > John DON'T USE THE RISPERDAL. It increases the risk of stroke in elderly patients. I recall that one of my nursing school textbooks says Risperdal is becoming the treatment of choice for dementia in elderly patients, but when I searched to provide you with a link to that effect, I discovered that the info in my nursing textbook is BAAAAD. The pharmaceutical company that manufactures of Risperdal says don't give it to elderly folks. This info has been available since 2003. Assuming the scrip was written in the past two years, the doc who wrote for the Risperdal needs to know about the safety alert so he doesn't continue to write for it in elderly folks. http://www.risperdal.com/ A quote from the link: "Important Safety Information Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. RISPERDAL® (risperidone) is not approved for the treatment of patients with Dementia-Related Psychosis." Safety alert for Risperdal: http://www.fda.gov/medwatch/SAFETY/2003/risperdal.htm copied from the link: "2003 Safety Alert - RISPERDAL (risperidone) -------------------------------------------------------------------------------- This is the text of a letter from Janssen Pharmaceutica Inc. Contact the company for a copy of any referenced enclosures. -------------------------------------------------------------------------------- JANSSEN PHARMACEUTICA INC. IMPORTANT DRUG INFORMATION 16-April-2003 Dear Healthcare Provider, Janssen Pharmaceutica Products, L.P., would like to inform you of important changes regarding RISPERDAL (risperidone). The RISPERDAL prescribing information has been updated with the addition of the following information: WARNINGS Cerebrovascular Adverse Events, Including Stroke, in Elderly Patients with Dementia Cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, were reported in patients (mean age 85 years; range 73-97) in trials of risperidone in elderly patients with dementia-related psychosis. In placebo-controlled trials, there was a significantly higher incidence of cerebrovascular adverse events in patients treated with risperidone compared to patients treated with placebo. RISPERDAL has not been shown to be safe or effective in the treatment of patients with dementia-related psychosis." Thanks very much!! Do you know if there is a report of the risks by dosage? This patient was prescribed 0.5 to 1.0 mg per day. John Curtiss wrote: > Anyone have experience with the effects of either on helping eldery patients > with dementia to sleep? [quoted text clipped - 6 lines] > > John DON'T USE THE RISPERDAL. It increases the risk of stroke in elderly patients. I recall that one of my nursing school textbooks says Risperdal is becoming the treatment of choice for dementia in elderly patients, but when I searched to provide you with a link to that effect, I discovered that the info in my nursing textbook is BAAAAD. The pharmaceutical company that manufactures of Risperdal says don't give it to elderly folks. This info has been available since 2003. Assuming the scrip was written in the past two years, the doc who wrote for the Risperdal needs to know about the safety alert so he doesn't continue to write for it in elderly folks. http://www.risperdal.com/ A quote from the link: "Important Safety Information Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. RISPERDAL® (risperidone) is not approved for the treatment of patients with Dementia-Related Psychosis." Safety alert for Risperdal: http://www.fda.gov/medwatch/SAFETY/2003/risperdal.htm copied from the link: "2003 Safety Alert - RISPERDAL (risperidone) ---------------------------------------------------------------------------- ---- This is the text of a letter from Janssen Pharmaceutica Inc. Contact the company for a copy of any referenced enclosures. ---------------------------------------------------------------------------- ---- JANSSEN PHARMACEUTICA INC. IMPORTANT DRUG INFORMATION 16-April-2003 Dear Healthcare Provider, Janssen Pharmaceutica Products, L.P., would like to inform you of important changes regarding RISPERDAL (risperidone). The RISPERDAL prescribing information has been updated with the addition of the following information: WARNINGS Cerebrovascular Adverse Events, Including Stroke, in Elderly Patients with Dementia Cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, were reported in patients (mean age 85 years; range 73-97) in trials of risperidone in elderly patients with dementia-related psychosis. In placebo-controlled trials, there was a significantly higher incidence of cerebrovascular adverse events in patients treated with risperidone compared to patients treated with placebo. RISPERDAL has not been shown to be safe or effective in the treatment of patients with dementia-related psychosis." > Thanks very much!! > > Do you know if there is a report of the risks by dosage? This patient was > prescribed 0.5 to 1.0 mg per day. Asking respectfully, why do you want to know that? Yesterday you said you hadn't given it yet. If you gave it last night, I think one dose isn't likely to produce a stroke. You're not thinking of giving it anyway, are you? I have somewhere to go now, but here's how I'd answer your question if I had time: Go to www.google.com, then click on "More" above the search box, then click on the little owl "scholar" link. Perform search queries including the combinations below: risperidone elderly stroke risperidone elderly CVA risperidone elderly cerebrovascular risperidone elderly dementia You should be able to produce one or more scholarly studies or abstracts thereof demonstrating risks from risperidone in elderly patients. Read the "conclusions" section for a summary of the study findings. Your answer may be in there somewhere. If you have trouble finding a free link: There will often be several links to choose from for any given study. Always choose the link that has "nih" and/or "gov" in it. Let me know if you run into trouble and I'll cough something up for you later. Good luck, --Patti Thanks again for the links. I went to this one: http://www.fda.gov/medwatch/SAFETY/2003/risperdal.htm and called the 800 number they gave just now. What they said was.... "Not recommended for dementia. Also, said that elimination from the body was decreased with Risperdal in elderly, so that if it were taken, dosing should be modified for elderly patients. Lower starting dose for elderly. 4-16mg/day is the typical dose for schizophrenia." I will check with the doc again about this before giving any. > > Thanks very much!! > > [quoted text clipped - 31 lines] > > --Patti > Thanks again for the links. I went to this one: > http://www.fda.gov/medwatch/SAFETY/2003/risperdal.htm and called the 800 [quoted text clipped - 7 lines] > > I will check with the doc again about this before giving any. Very good. I have no doubt the doc knows a great deal more than I do, and when I looked at some studies, there seems to be an ongoing controversy about using risperidone for dementia. (That is, it may be okay.) Your patient's doc may feel the benefits of giving this med outweigh the risks. However, if I had an elderly family member with dementia, I'd need some convincing before I gave this med, because it's an off-label use, and there may be other adequate drugs that aren't implicated in strokes in elderly patients. --Patti > > Thanks again for the links. I went to this one: > > http://www.fda.gov/medwatch/SAFETY/2003/risperdal.htm and called the 800 [quoted text clipped - 18 lines] > > --Patti Thanks again. I'm overly cautious myself when it comes to medications, so I appreciate what you're saying. By the way, I dont' know if this is of any interested to anyone, but I just learned that there is a symposium targeted toward care-givers, being held on Saturday, February 04, 2006 for anyone in the Los Angeles area. I talked to the lady coordinating it today and the emphasis is going to be on the latest medications and medications that are just about to be approved by FDA. Here are the details... Northridge Hospital Medical Center Center for Aging, Research and Education Penthouse Auditorium Northridge CA 9 am to 12 pm - Registration Required APDA I & R Center (Free, I think) Directions: Take the 405 Fwy to San Fernando Valley and exit on Roscoe. Head west. Hospital is on the corner of Roscoe & Reseda. For more info, call 818-885-8623 or valleyapda@yahoo.com I don't remember where I got the info from - one of the Parkinsons disease websites. John > Thanks very much!! > [quoted text clipped - 76 lines] > placebo. RISPERDAL has not been shown to be safe or effective in the > treatment of patients with dementia-related psychosis." |
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