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Original article
peer-reviewed

Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations



Abstract

In recent years, antipsychotic medications have increasingly been used in pediatric and geriatric populations, despite the fact that many of these drugs were approved based on clinical trials in adult patients only. Preliminary studies have shown that the “off-label” use of these drugs in pediatric and geriatric populations may result in adverse events not found in adults. In this study, we utilized the large-scale U.S. Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) database to look at differences in adverse events from antipsychotics among adult, pediatric, and geriatric populations. We performed a systematic analysis of the FDA AERS database using MySQL by standardizing the database using structured terminologies and ontologies. We compared adverse event profiles of atypical versus typical antipsychotic medications among adult (18-65), pediatric (age < 18), and geriatric (> 65) populations. We found statistically significant differences between the number of adverse events in the pediatric versus adult populations with aripiprazole, clozapine, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and thiothixene, and between the geriatric versus adult populations with aripiprazole, chlorpromazine, clozapine, fluphenazine, haloperidol, paliperidone, promazine, risperidone, thiothixene, and ziprasidone (p < 0.05, with adjustment for multiple comparisons). Furthermore, the particular types of adverse events reported also varied significantly between each population for aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (Chi-square, p < 10-6). Diabetes was the most commonly reported side effect in the adult population, compared to behavioral problems in the pediatric population and neurologic symptoms in the geriatric population. We also found discrepancies between the frequencies of reports in AERS and in the literature. Our analysis of the FDA AERS database shows that there are significant differences in both the numbers and types of adverse events among these age groups and between atypical and typical antipsychotics. It is important for clinicians to be mindful of these differences when prescribing antipsychotics, especially when prescribing medications off-label.



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Original article
peer-reviewed

Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations


Author Information

Hersh Sagreiya Corresponding Author

Radiology, University of Pittsburgh Medical Center

Yi-Ren Chen

Department of Neurosurgery, Stanford University Medical Center

Narmadan A. Kumarasamy

Radiology, Montefiore Medical Center

Karthik Ponnusamy

Orthopedics, Western University

Doris Chen

Internal Medicine, Stanford University Medical Center

Amar K. Das

Healthcare and Life Sciences, IBM T.J. Watson Research Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Original article
peer-reviewed

Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations


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Original article
peer-reviewed

Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations

  • Author Information
    Hersh Sagreiya Corresponding Author

    Radiology, University of Pittsburgh Medical Center

    Yi-Ren Chen

    Department of Neurosurgery, Stanford University Medical Center

    Narmadan A. Kumarasamy

    Radiology, Montefiore Medical Center

    Karthik Ponnusamy

    Orthopedics, Western University

    Doris Chen

    Internal Medicine, Stanford University Medical Center

    Amar K. Das

    Healthcare and Life Sciences, IBM T.J. Watson Research Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: February 26, 2017

    DOI

    10.7759/cureus.1059

    Cite this article as:

    Sagreiya H, Chen Y, Kumarasamy N A, et al. (February 26, 2017) Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations. Cureus 9(2): e1059. doi:10.7759/cureus.1059

    Publication history

    Received by Cureus: December 18, 2016
    Peer review began: January 08, 2017
    Peer review concluded: February 19, 2017
    Published: February 26, 2017

    Copyright

    © Copyright 2017
    Sagreiya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

In recent years, antipsychotic medications have increasingly been used in pediatric and geriatric populations, despite the fact that many of these drugs were approved based on clinical trials in adult patients only. Preliminary studies have shown that the “off-label” use of these drugs in pediatric and geriatric populations may result in adverse events not found in adults. In this study, we utilized the large-scale U.S. Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) database to look at differences in adverse events from antipsychotics among adult, pediatric, and geriatric populations. We performed a systematic analysis of the FDA AERS database using MySQL by standardizing the database using structured terminologies and ontologies. We compared adverse event profiles of atypical versus typical antipsychotic medications among adult (18-65), pediatric (age < 18), and geriatric (> 65) populations. We found statistically significant differences between the number of adverse events in the pediatric versus adult populations with aripiprazole, clozapine, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and thiothixene, and between the geriatric versus adult populations with aripiprazole, chlorpromazine, clozapine, fluphenazine, haloperidol, paliperidone, promazine, risperidone, thiothixene, and ziprasidone (p < 0.05, with adjustment for multiple comparisons). Furthermore, the particular types of adverse events reported also varied significantly between each population for aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (Chi-square, p < 10-6). Diabetes was the most commonly reported side effect in the adult population, compared to behavioral problems in the pediatric population and neurologic symptoms in the geriatric population. We also found discrepancies between the frequencies of reports in AERS and in the literature. Our analysis of the FDA AERS database shows that there are significant differences in both the numbers and types of adverse events among these age groups and between atypical and typical antipsychotics. It is important for clinicians to be mindful of these differences when prescribing antipsychotics, especially when prescribing medications off-label.



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Hersh Sagreiya

Radiology, University of Pittsburgh Medical Center

For correspondence:
sagreiya@gmail.com

Yi-Ren Chen, M.D., M.P.H.

Department of Neurosurgery, Stanford University Medical Center

Narmadan A. Kumarasamy

Radiology, Montefiore Medical Center

Karthik Ponnusamy

Orthopedics, Western University

Doris Chen

Internal Medicine, Stanford University Medical Center

Amar K. Das

Healthcare and Life Sciences, IBM T.J. Watson Research Center

Hersh Sagreiya

Radiology, University of Pittsburgh Medical Center

For correspondence:
sagreiya@gmail.com

Yi-Ren Chen, M.D., M.P.H.

Department of Neurosurgery, Stanford University Medical Center

Narmadan A. Kumarasamy

Radiology, Montefiore Medical Center

Karthik Ponnusamy

Orthopedics, Western University

Doris Chen

Internal Medicine, Stanford University Medical Center

Amar K. Das

Healthcare and Life Sciences, IBM T.J. Watson Research Center