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Off-Label Use of Atypical Antipsychotics: An Update

Slide: 35 of 47

Adverse Effects in Elderly Patients: Placebo Comparisons (3 of 3)

In summary, a meta-analysis of placebo comparison studies yielded the following results:

  • Extrapyramidal symptoms are common with risperidone and olanzapine.
  • Atypical antipsychotics are associated with sedative effects and fatigue.
  • Atypical antipsychotics elevate the risk of urinary adverse effects in elderly patients (65 or older), but the evidence is too limited to permit conclusions about the degree of risk.

No statistically significant difference in the rate of extrapyramidal symptoms was found in a meta-analysis of 4 studies of aripiprazole with a total of 1,080 participants. Extrapyramidal symptoms are found in 1 of 10 patients treated with olanzapine, as determined in 1 study of 242 participants. No statistically significant difference in the rate of extrapyramidal symptoms was found in a meta-analysis of 3 studies of quetiapine with a total of 609 participants. Extrapyramidal symptoms are found in 1 of 20 patients treated with risperidone, as determined in 5 studies with a total of 1,477 participants. The strength of evidence for the finding about extrapyramidal symptoms is moderate.

Sedative effects were found in 1 of 16 patients treated with aripiprazole, in a meta-analysis of 4 studies of aripiprazole with a total of 1,080 participants. Sedative effects were found in 1 of 9 patients treated with olanzapine, as determined in 5 studies with a total of 1,218 participants. Sedative effects were found in 1 of 4 patients treated with quetiapine, as determined in 4 studies with a total of 799 participants. Sedative effects were found in 1 of 10 patients treated with risperidone, as determined in 5 studies with a total of 2,182 participants. The strength of evidence for findings about sedative effects is moderate.

Fatigue was found in 1 of 22 patients treated with aripiprazole, in a meta-analysis of 3 studies of aripiprazole with a total of 872 participants. Fatigue was found in 1 of 34 patients treated with olanzapine, as determined in 3 studies with a total of 808 participants. Fatigue was found in 1 of 34 patients treated with quetiapine, as determined in 3 studies with a total of 569 participants. Fatigue was found in 1 of 34 patients treated with risperidone, as determined in 2 studies with a total of 517 participants. The strength of evidence for findings about fatigue is moderate.

No statistically significant difference in weight gain was found in patients treated with aripiprazole, in a meta-analysis of 2 studies of aripiprazole with a total of 695 participants. Weight gain was found in 1 of 24 patients treated with olanzapine, as determined in 3 studies with a total of 808 participants. The strength of evidence for this finding is moderate. No statistically significant difference in weight gain was found in patients treated with quetiapine, as determined in 1 study of 236 participants. Weight gain was found in 1 of 24 patients treated with risperidone, as determined in 2 studies with a total of 517 participants. The strength of evidence for findings about weight gain is high.