Medications that can be dangerous for dementia
Happy Tuesday Careblazer!
Today I want to talk about some of the most dangerous medications for older adults with dementia. These medications have something called a “black box warning”.
If you would rather watch a video on this topic, click here.
When a medication has a black box warning, it means it has the most stringent warning for drugs and medical devices and the FDA requires a black box warning be placed on the medication or device packaging. The information must have a header in all caps and information printed in bold typeface. These warnings notify the public of serious, permanent or fatal side effects. You might be surprised to hear that some of the most common medications given to people with dementia with behavioral challenges include medications with these black box warnings because they can lead to things like stroke and death. Despite these warnings, studies suggest that these medications continue to be prescribed on a regular basis.
Before I go any further I want to say that this does not mean no person with dementia should be on these medications. This is a conversation for you to have with your loved one’s prescribing provider and things like severity of the aggression and risk for others must be considered. The black box warning encourages physicians to carefully consider the risks and benefits, before prescribing a drug that has a potentially disabling or fatal reaction but it doesn’t mean it should never ever be prescribed.
That being said, I do think it’s important you are aware of this as some people aren’t aware at all of this warning and are eager to take any medication that promises to get rid of challenging behavior. So this video is to inform you and give you some food for thought to talk to your loved one’s doctor about and tell you the names of some of these medications. This is not to tell you whether or not your loved one should take certain meds. That’s way beyond my scope as a psychologist.
Okay, so let’s get to some of these medications that are commonly prescribed to people with dementia but have these black box warnings. These medications are in the category called antipsychotic medications. And in the past they were prescribed to people with dementia and challenging behaviors to use “off label” meaning these drugs were made to treat symptoms of psychotic disorders such as schizophrenia but then started to be prescribed to people with dementia in hopes it would help. In 2005, the FDA issued a black box warning for antipsychotics with use in dementia because studies showed it was leading to stroke, infection, and ultimately death significantly more than people prescribed a placebo (aka a sugar pill).
Names of these antipsychotics include:
haloperidol or Haldol
olanzapine or Zyprexa
quetiapine or Seroquel
risperidone or Risperdol
ABILIFY or (aripiprazole)
Because of the dangers in many of the meds used to treat the behavioral symptoms that are common in dementia, non-medication approaches should always be the first line approach Here I have linked an entire playlist of videos I did on how to respond to some of those behaviors. Click here to watch that playlist. And even in cases where medications are determined necessary, behavioral approaches should still also be used in conjunction with the medication.
I’m including a link to a really good article that talks about evidenced based treatments of using black box warning medications. You can download it for free here if you want to know the research.
I’m really curious if your loved one has been prescribed any of these medications and if so, was the black box warning discussed? Let me know in the comments below. A 2011 survey of 107 nursing home facilities showed that most facilities do have a policy requiring families to sign consent allowing that medication. Here is a link to that survey if you are interesting in diving into that research
I’m interested to hear your thoughts! I hope you all have a wonderful week and I'll be back next week with another blog post.
