Antipsychotic drug prescribing in the elderly is cause for concern

Despite most studies of antipsychotic efficacy and safety having been conducted in young patients with schizophrenia, antipsychotic agents are often prescribed in elderly subjects with psychotic symptoms. The aim of this study was to document and describe the level of antipsychotic exposure among elderly subjects. We used the Regional Administrative Database of Lombardy, a region of northern Italy with more than 1.6 million elderly inhabitants, to extract all antipsychotic prescriptions dispensed during 2001 to subjects aged 65 years or above. Prevalence data were calculated by dividing antipsychotic users by the total number of male and female residents in each age group. During the 12 months surveyed 35 363 subjects received at least one antipsychotic prescription, yielding a prevalence of use of 2.18 subjects per 100 inhabitants (95% confidence interval 2.16-2.20). Almost two-thirds were prescribed first-generation agents only, and thioridazine, a first-generation agent associated with prolonged QTC interval, and which is restricted in most European countries, was the most prescribed agent. However, risperidone and olanzapine accounted for 30% of antipsychotic use for all subjects. The majority of patients were also prescribed agents for medical disorders. Because the population of Lombardy is approximately one-sixth of the entire Italian population, it can be assumed that there are over 200 000 elderly subjects annually exposed to these agents in Italy. This generates particular concern because elderly patients are vulnerable to the adverse effects of antipsychotics, and recent warnings have indicated that there are cerebrovascular risks associated with risperidone and olanzapine therapy.