Antipsychotic therapy: risks and benefits at end of life

摘要

Antipsychotics are frequently used in the palliative care setting for a variety of symptoms and disorders, including delirium or agitation, nausea and vomiting, and insomnia. Evidence is most supportive of their use in the management of delirium and nausea and vomiting. However, antipsychotics, particularly the atypical agents, have complex mechanisms and receptor binding and, as a result, provide benefit for various symptoms or clusters of symptoms. Therapeutic outcomes may differ by type of agent (typical versus atypical antipsychotic) and the underlying mechanisms. The overall benefits of antipsychotics in palliative care should be carefully balanced with the potential adverse effects. In addition to extrapyramidal symptoms, antipsychotics are associated with numerous adverse effects, including the metabolic syndrome, increased prolactin levels, QTc prolongation, and increased mortality. Recently, published evidence has found little difference between the atypical and typical antipsychotics in regards to mortality or sudden cardiac death.