RISPERIDONE IN THE ELDERLY - A PHARMACOEPIDEMIOLOGIC STUDY

Background: The possibly limited adverse effects of risperidone encour age interest in its use in geriatric patients. Method: Medical records of 122 hospitalized psychogeriatric patients (greater than or equal t o 65 years old) newly treated with risperidone were reviewed and score d for indications, doses, and effects of this novel neuroleptic. Resul ts: Subjects (83 women, 39 men), mean +/- SD age = 76.5 +/- 6.8 years (range, 65-95), were given risperidone for agitation or psychosis asso ciated with dementia (53%), a major mood disorder (29%), or other diso rders (18%). Most (77%) were also medically ill and received other psy chotropic (76%) or cardiovascular agents (70%). Daily doses of risperi done averaged 1.6 +/- 1.1 mg (range, 0.25-8.0) (0.025 mg/kg body wt.); 78% received 2.0 mg. Risperidone appeared to be effective in 85% of c ases, but 18% were discontinued due to intolerability (11%) or ineffic acy (7%). Adverse events occurred in 32% of the patients (36% of those discontinued). These adverse events included hypotension (29%) or sym ptomatic orthostasis (10%), cardiac arrest(1.6%) with fatality (0.8%), and extrapyramidal effects(11%) or delirium (1.6%). Benefits were ass ociated with younger age and male gender, but not risperidone dose. Ad verse effects were associated with cardiovascular disease and its trea tment, cotreatment with an SRI antidepressant or valproate, and relati vely rapid dose increases. Conclusion: Risperidone appeared to be effe ctive and may be safe for many elderly psychiatric patients with comor bid medical conditions provided that doses are low and increased slowl y. Particular caution is advised in the presence of cardiovascular dis ease or cotreatment with other psychotropic agents.