Sultzer, whose clinical practice is in Alzheimer disease, said that because of the issues of mortality, cerebrovascular and cardiovascular adverse effects, and the FDA’s black box warning, he has been prescribing more cautiously, but he does sometimes use atypical antipsychotics, as do other clinicians.
Behavioral symptoms, particularly physical aggression, can be devastating for both the patient and the caregivers, he explained. “With the increased awareness of risks of antipsychotics, there has been greater enthusiasm for identifying alternative compounds as well as how best to implement behavioral strategies. Unfortunately . . . there really is far less known about other medications, and what is known, doesn’t suggest there is a magic bullet,” Sultzer said. “If you want to base a treatment on known effects, antipsychotics are one of the better categories because there have been many clinical trials data looking at their efficacy and side effects.”
Sultzer believes “behavioral interventions can be as effective or more so in some cases than particular medicines, and should be considered in all cases. The challenge is how best to implement those behavioral interventions.”
Bottom-line, Sultzer said, is that the clinician must really understand the individual patient’s clinical circumstances and the potential for benefit from a particular treatment given his or her particular risk.