Off-label antipsychotic use widespread among older adults, study finds

A large registry study in Finland by the University of Oulu and the University of Eastern Finland shows that many older adults receive antipsychotic medications for purposes other than those officially approved. Known as off-label use, this practice occurs when a doctor prescribes a drug for a condition not listed in its official indication.

The researchers analyzed Finnish national registry data on 209,346 older adults living at home who did not have Alzheimer’s disease. They compared three groups: off-label users, people taking antipsychotics for an official indication, and those not using the medications at all. The paper is published in the Nordic Journal of Psychiatry.

The results were striking: 70% of all antipsychotic use fell into the off-label category. Use of these medications off-label also increased over the course of the study period. Risperidone and quetiapine were the most commonly used antipsychotics off-label.

Physicians often prescribe antipsychotics to older patients to manage prolonged behavioral symptoms or insomnia, despite the absence of official approval for these conditions. Previous research has even suggested that using these drugs without alternative non-drug treatments can constitute a form of elder abuse. Limited resources in elderly care and a lack of non-pharmacological options appear to have contributed to the growing use of these medications.

The study found that off-label users were more likely than other groups to have cardiovascular diseases and cerebrovascular disorders. They were also more likely to be using opioids.

“Surprisingly, off-label users had cardiovascular and cerebrovascular conditions even more frequently than patients prescribed antipsychotics for an approved indication, such as psychotic disorders,” said postdoctoral researcher Tuomas Majuri of the University of Oulu.

Majuri noted that this finding could reflect insufficient monitoring of the metabolic side effects of these medications when used off-label.

The researchers say their findings underscore the need for alternative treatments for symptoms currently managed with off-label antipsychotic use.

“Clearer guidelines are needed for monitoring metabolic side effects, and measures must be taken to promote safer prescribing practices,” Majuri added.