Adverse effects associated with antipsychotic use in older adults
Abstract
INTRODUCTION: Antipsychotic (AP) medications are extensively utilized for diverse psychiatric and non-psychiatric conditions, but they are associated with significant adverse effects in older adults. This expert opinion review provides an updated profile of adverse effects associated with AP medications in older adults. AREAS COVERED: This review specifically examines real-world evidence for adverse events associated with AP use, including all-cause mortality, falls and fractures, diabetes, cardiovascular and cerebrovascular events, acute kidney injury, venous thromboembolism/pulmonary embolism, extrapyramidal symptoms, and infections based on real-world evidence. EXPERT OPINION: This comprehensive safety review of AP revealed multiple adverse events in older adults. All-cause mortality, more associated with typical APs than atypicals, underscores a dose-dependent risk, urging cautious prescribing practices and avoidance of typical APs. Falls/fractures associated with atypical APs highlight the importance of judicious dosing and -close monitoring, especially after initiation. Cardiovascular risks, particularly stroke, with AP use emphasize the need for vigilant monitoring. Extrapyramidal symptoms, more linked to typical APs, also pose a significant risk in older adults. Pneumonia and pulmonary embolism/venous thromboembolism demand cautious consideration of APs, prompting the need for additional real-world studies to inform clinical practice. Conflicting evidence on diabetes and acute kidney injury necessitates ongoing studies and further research in older adults.
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Antipsychotics are associated with increased cardiovascular risk in the elderly.
“Similarly, antipsychotics are associated with increased cardiovascular risk in the elderly. 98”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [98]
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Stelzer, F. G., Bacelar, A., Éckeli, A. L., Negrão, A. B., Almeida, C. M. O., Franco, C. M. R., Pires, G. N., Gitaí, L. L. G., Sobreira-Neto, M. A., Assis, M., et al. (2025) · Arquivos de Neuro-Psiquiatria · doi:10.1055/s-0045-1812323 · Cited by 1 · see citing works
- Authors
- Khalid, J., & Aparasu, R. R.
- Affiliations
- University of Houston (US)
- Corresponding author
- Aparasu, Rajender R.
- Venue
- Expert Opinion on Drug Safety
- Publisher
- Informa UK Limited
- Published
- 2024-08-12
- Volume
- 23
- Issue
- 9
- Pages
- 1157-1171
- ISSN
- 1474-0338 (ISSN-L)
- 1744-764X
- OpenAlex
- W4401143015
- Cited by
- 17
- References
- 84
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 1
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Opinion on Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- antipsychotic adverse effects, older adults, all-cause mortality, falls and fractures, diabetes mellitus, cardiovascular events, cerebrovascular events, acute kidney injury, venous thromboembolism, pulmonary embolism, extrapyramidal symptoms, pneumonia, drug safety
- MeSH terms
- Accidental Falls, Age Factors, Aged, Mental Disorders, Dose-Response Relationship, Drug, Humans, Antipsychotic Agents, Drug Monitoring
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