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Atypical neuroleptics: renal failure in elderly patients

In addition to their many known adverse effects, neuroleptics expose elderly patients to renal failure.

Neuroleptics have numerous adverse effects, varying in severity: sedative, atropine-like effects, extrapyramidal (in particular with movement disorders), endocrine and cardiac disorders.

Compared with traditional neuroleptics, high doses of atypical neuroleptics expose patients to fewer extrapyramidal adverse effects in the short term, but put them at a greater risk of weight gain, hyperglycaemia and diabetes.

A Canadian team also found that patients aged over 65 have a statistically significant higher risk of hospitalisation with acute renal failure within 90 days of being prescribed the atypical oral neuroleptics risperidone, quetiapine or olanzapine: around 1% of patients taking one of these neuroleptics as opposed to around 0.6% not prescribed them.

The findings revealed adverse effects contributing to renal failure: arterial hypotension, acute urinary retention, pneumonia, myocardial infarction and ventricular arrhythmia. The mortality rate from all causes also appeared to be higher.

In practice, when an elderly patient is given neuroleptics despite the risk of adverse effects, it is advisable to monitor renal function.

©Prescrire 1 November 2015

"Atypical neuroleptics in elderly patients: acute kidney injury " Prescrire Int 2015; 24 (165): 267. (Pdf, subscribers only).

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