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Geriatric Medicine

Discontinuing Risperidone?

By: MARY ANN MOON

01/22/13

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Among patients with Alzheimer’s disease who develop psychosis or agitation-aggression that responds to risperidone, discontinuing the drug as advised after 3-6 months is associated with a doubling of the rate of relapse, according to a study published in the New England Journal of Medicine.

“Federal regulations for nursing homes strongly urge discontinuation of antipsychotic drugs after 3-6 months of treatment” because of concern about adverse effects, even though “evidence from controlled trials in support of this long-standing regulation is very limited,” said Dr. D.P. Devanand of the New York State Psychiatric Institute and Columbia University, New York, and his associates.

Dr. D. P. Devanand

“Our findings suggest that patients with psychosis or agitation-aggression who have a sustained response to antipsychotic treatment for 4-8 months have a significantly increased risk of relapse for at least 4 months after discontinuation, and this finding should be weighed against the risk of adverse effects with continued antipsychotic treatment,” they noted (N. Engl. J. Med. 2012;367:1497-1507).

Dr. Jay Luxenberg, chief medical officer of On Lock LIfeways in San Francisco, commenting on the results, noted that "25% of those initially randomized to being switched to placebo completed the 48-week study without relapse, whereas 31% of those who remained on risperidone were without relapse. That means only a 6% absolute increase in relapse-free state by staying on risperidone for almost a year. I believe that does not really mean that our usual practice in long-term care – periodic dose reductions rather than the abrupt discontinuation used in this study – should change based on this study."

This study was funded by the National Institutes of Health and the U.S. Department of Veterans Affairs. Dr. Devanand and his associates reported numerous ties to industry sources.

–Mary Ann Moon



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