Risperdal, Haldol Worsen Delirium In Patients Undergoing Palliative Care: Study

The findings of a new study suggest that Risperdal and Haldol may be no more beneficial than a placebo for calming symptoms of delirium among individuals undergoing pain management during palliative care. 

Australian researchers report that they conducted a randomized clinical trial involving 247 patients undergoing palliative care, who were under distress and suffering from delirium. The study compared the effects of Risperdal and Haldol with an inactive placebo, and the findings were published this month in the medical journal JAMA Internal Medicine.

Concerns have existed for years about the use of Risperdal, Haldol and other antipsychotic medications as a form of “chemical restraint” among the elderly or those with signs of dementia. Although the drugs are prescribed in those cases to calm patients and make them more controllable, studies have shown that antipsychotics not only fail to provide those patients with benefits, but could increase their risk of death.

This latest study looked at similar use of these drugs in reducing delirium suffered by patients in an extreme amount of pain. Of the 247 participants, 82 were given Risperdal, 81 received Haldol, and 84 were given a placebo. According to the findings, those given Risperdal and Haldol not only failed to see reduced delirium, but the symptoms of delirium appeared to increase when compared to the effects of a placebo.

In what may confirm previous warnings about an increased risk of death, patients given Haldol had a worse chance of survival than those given a placebo as well. However, the same effect was not seen with the Risperdal subjects.

The FDA has previously warned against the use of antipsychotics with dementia patients, indicating that the medications provide no benefits and may increase the risk of death. Given what is known about the potential side effects of antipsychotics, use of the medications is often considered a form of elderly abuse when the purpose is to sedate the individual, rather than treat.

In September 2014, the National Partnership to Improve Dementia Care announced that it has set a goal of reducing the use of antipsychotics in long-term care facilities by 25% before the end of 2015. The group, headed by the Centers for Medicare and Medicaid Services (CMS) hopes to see reductions of 30% by the end of 2016.

Currently, about 25% of elderly dementia patients in nursing homes in the U.S. are treated with antipsychotics, many of whom, if not most or all, do not need them.

The rates of use among patients with palliative care are less clear, but the researchers said it appeared that individualized treatment and supportive care have more beneficial results, similar to findings in relation to patients with dementia.

“In patients receiving palliative care, individualized management of delirium precipitants and supportive strategies result in lower scores and shorter duration of target distressing delirium symptoms than when (Risperdal) or (Haldol) are added,” the researchers concluded.