Study Finds Questionable Prescribing of Antiepileptic Drugs to Nursing Home Patients with Dementia

While recent research has found an overall decrease in the prescription of unnecessary opioid and antipsychotic medications to nursing home patients, the findings of a new study indicates there has been an increase in the use of anti-seizure drugs that may not be medically necessary.

In a study published this month in the Journal of the American Geriatrics Society, researchers from University of Pennsylvania in Philadelphia reviewed the trends of prescriptions medications given to nearly one million nursing home residents with Alzheimer’s disease and related dementias, finding more patients are being prescribed antiepileptic medications like Depakote and Neurontin, which have shown little scientific benefit for such conditions.

Similar trends were seen in prior years with the use of antipsychotics, which research has shown provide no benefits for dementia patients, yet increase their overall risk of death.

The U.S. Food and Drug Administration (FDA) has issued warnings against the use of nursing home antipsychotics with dementia patients, due to the risks and lack of benefits. This tactic of pacifying dementia patients with drugs is known as “chemical restraint” and is often considered a form of nursing home abuse.

However, since the agency issued a black box warning for chemical restraint drugs in 2005, other studies have similarly found a reduction in the use of the drugs, and a shift to alternative medications. These drugs provide behavioral-control and calming effects like hypnotics, antiepileptic’s and opioids, but also increased the risk of cardiovascular events among seniors.

In this latest study, researchers reviewed prescriptions for 973,074 individuals diagnosed with Alzheimer’s disease and related dementias (ADRD) who had a long-term stay in a nursing home, which was defined as at least three months. The researchers also examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain.

While the study indicates antipsychotic prescribing rates declined from 32.1% to 27.9%, and opioid prescribing rates declined from 39.8% to 31.7% from 2015 through 2019, researchers identified an increase in the use of the antiepileptic drugs Depakote (valproic acid) and Neurontin (gabapentin), increasing from 29.5 % in 2015 to 31.3 % in 2019.

Researchers raised concerns over the increased use of antiepileptic drugs on patients with ADRD, as little scientific evidence has been provided to show any medical benefit for symptoms of dementia. Given the lack of clinical benefit, the authors questioned the reasoning behind the increase in prescribing of antiepileptic drugs, and whether there is a hidden intent behind their administration.

Questionable Use of Antiepileptic Drugs in Nursing Homes

Antiepileptic drugs like Depakote and Neurontin are in a class of medications called anticonvulsants. Neurontin treats seizures by decreasing abnormal excitement in the brain, while Depakote can treat seizures and bipolar disorder. However, for both drugs, studies have reported mixed findings in the effectiveness in treating dementia.

One effect that both medications do provide, is a calming effect due to their properties that impact the neurons in the brain, which raises concerns they are being used as a new form of chemical restraint; replacing antipsychotics.

“Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways,” the researchers concluded. “Antiepileptic prescribing of questionable risk–benefit for dementia care warrants further scrutiny.”

Nursing Home Chemical Restraint Concerns

The FDA has previously warned against the use of antipsychotics among dementia patients. However, since the agency issued a black box warning for chemical restraint drugs in 2005, other studies have similarly found a reduction in the use of the drugs, and a shift to alternative medications.

These drugs provide behavioral-control and calming effects like hypnotics, antiepileptic’s and opioids, which also increased the risk of cardiovascular events among seniors.

When used improperly, instead of when patients may harm themselves, chemical restraint drugs can lead to unnecessary side effects, such as bed sores, physical injuries, falls, fractures and in some cases death. When used in inappropriate ways it is considered nursing home abuse.