APRIL SAUL / Staff Photographer
Bill Wiggins and his wife, Kathye, who has suffered from Alzheimer's disease since age 53, in their Yardley home. He is assisted at home by caregiver Christine Quoikapor.
Elderly patients boost sales of dangerous antipsychotics
Bill Wiggins believes a powerful antipsychotic medication helped save his wife, Kathye.
Helen Shields believes one of these drugs helped kill her mother, Helen Marciniszyn.
Two families, two drugs, two stories that capture the extremes of a debate about using these medicines to treat the diseases of aging when there are no other effective alternatives.
Kathye Wiggins took Johnson & Johnson's Risperdal. Marciniszyn took AstraZeneca's Seroquel. Both drugs are atypical antipsychotics, a category of psychotropic drugs that also includes Zyprexa from Eli Lilly & Co., Abilify by Bristol-Myers Squibb Co., and Pfizer Inc.'s Geodon.
The federal government approved atypicals in the 1990s to treat schizophrenia and bipolar disorder. Since then, they have become popular for treating disorders including autism and Alzheimer's, despite mixed evidence that they help and ample evidence that they hurt.
Doctors prescribe atypicals for these illnesses because they may calm people and help them sleep. Also, patients with Alzheimer's and dementia can lose touch with reality, as schizophrenics do, so, in theory, atypicals could help.
Sales of atypicals rose to $14.36 billion in 2008 from $8.4 billion in 2003, according to data provider IMS Health.
Elderly patients have been a major source of that growth. Studies suggest that 20 percent to 30 percent of nursing-home residents take an atypical, despite not having a psychosis diagnosis.
In Pennsylvania and New Jersey, about 16 percent of all such patients on Medicare or Medicaid take some type of antipsychotic, according to federal figures. The numbers jump to more than 40 percent when the category is narrowed to patients with cognitive impairment or behavior problems.
The drugs have life-threatening side effects, especially in the elderly. Several studies have said they increase the risk of heart attacks, stroke, and premature death in this group. The atypicals now carry a so-called black box warning - the most serious required by the U.S. Food and Drug Administration - saying patients with dementia who take them are "at increased risk of death."
There is also potential for abuse.
In February,, California's attorney general charged three staff members at a nursing home with using Risperdal and Zyprexa to sedate patients and make them easier to manage. In a separate case in January, Lilly agreed to pay the federal government $1.4 billion to settle charges that it illegally marketed Zyprexa for use by the elderly.
Benefits and risks
Deciding whether to use a drug always involves weighing benefits against risks, but that calculation is especially complex when it comes to using atypicals for Alzheimer's and dementia.
"These drugs are our friends as well as our foes," said Carol Lippa, director of Drexel University's Dementia Neurology Research Laboratory. "You don't want to use them if you don't have to."
The controversy is hardly new and is expected to grow as the population ages. Diseases such as Alzheimer's and dementia have always posed challenges to caregivers. There are no substantive treatments. The FDA has not approved atypicals to treat Alzheimer's or dementia, but doctors, lacking alternatives, often prescribe them.
Patients with Alzheimer's and dementia wander, curse, or attack families and nursing aides. Many need 24-hour one-on-one care, a challenging standard in a busy family or understaffed nursing facility.
Historically, these patients were tied down or otherwise physically restrained, which now can be illegal. Various pills, including the atypicals, often have seemed more humane.
Before the atypicals arrived, geriatric experts worried about the use of earlier antipsychotics such as Haldol. Atypicals have grabbed the spotlight recently, but many doctors say they also worry about the overuse of antidepressants and anti-anxiety drugs in the elderly.
As evidence surfaced in the 1980s that some elderly patients were being medicated into submission, Congress passed laws making overuse of psychiatric drugs, or "chemical restraint," illegal.
