Fully one in seven people with dementia who do not live in nursing homes are taking at least three drugs that act on the central nervous system — beyond the limit advised by medical experts, a new study finds.
The federal government has long regulated the use of these drugs in nursing homes. Taken together and/or off-label, they can raise the risk of falls, overdose and memory issues, among other adverse consequences.
The practice may be understandable, acknowledged Donovan Maust, M.D., M.S., a geriatric psychiatrist with Michigan Medicine, of the University of Michigan. Care providers for people who live in less-regulated settings such as assisted living communities or at home may naturally seek to address dementia-related behavioral issues through medication, he said.
“But the evidence supporting the use of many [central nervous system drugs] in people with dementia is pretty thin, while there is a lot of evidence about the risks — especially when there are multiple medications layered on top of one another,” he said.
In a new investigation, Maust and his colleagues found that antipsychotics, for example, were prescribed to 47% of those taking three or more of the medications in the study. Although they are contraindicated for people with dementia, they are often given to these patients for agitation, sleep issues, and other problems.
Other common components of these multi-drug regimens were antidepressants (in 92% of participants), anti-seizure medications (62%) and benzodiazepines, such as lorazepam. Many of the medications appeared to be prescribed off-label, as the drugs did not match recorded symptoms, the researchers found.
“It appears that we have a lot of people on a lot of medications without a very good reason,” said Maust, an expert on medication for dementia-related behaviors.
A regular prescription drug review could help spot risky drug combinations, especially involving three or more drugs that act on the brain and nervous system, he and his colleagues suggested. Medicare covers such appointments with providers or pharmacists, they noted.
The study team said it now is reviewing which providers type prescribed each central nervous system-acting drug to study participants with a multi-medication regimen. They aim to uncover prescribing patterns that can be used to further educate clinicians on limiting their use of these drugs.
The study was published in JAMA.