McKean Andrew, Monasterio Erik
Hillmorton Hospital, Christchurch, New Zealand.
Expert Rev Clin Pharmacol. 2015 Jan;8(1):5-7. doi: 10.1586/17512433.2015.974557. Epub 2014 Oct 29.
Atypical antipsychotics (AAP) have become some of the most commonly prescribed medications in primary and specialist care settings. Off-label prescribing accounts for much of the expanded use of AAPs. This has become common in the elderly. Marketing by pharmaceutical companies appears to have contributed to the off-label use of AAPs, in situations where their safety and efficacy is far from established. Although evidence provides varying degrees of support for their use for behavioural and psychological symptoms of dementia, augmentation of antidepressants in depression, anxiety, insomnia and in the management of psychosis in Parkinson's Disease, there are a number of potential problems with their expanded use in the elderly. These include weight gain, type two diabetes mellitus, sudden cardiac death and increased mortality rates in the elderly with dementia. It is recommended that whenever AAPs are used off-label, a review date is identified, informed consent is obtained and treatment and side-effects are closely monitored.
非典型抗精神病药物（AAP）已成为基层医疗和专科护理环境中最常用的处方药之一。超说明书用药在AAP的广泛使用中占了很大比例。这在老年人中很常见。制药公司的营销似乎促成了AAP的超说明书使用，而其安全性和有效性远未得到证实。尽管有证据为其用于痴呆症的行为和心理症状、抑郁症中抗抑郁药的增效、焦虑症、失眠症以及帕金森病精神病的管理提供了不同程度的支持，但在老年人中广泛使用它们存在一些潜在问题。这些问题包括体重增加、2型糖尿病、心源性猝死以及老年痴呆症患者死亡率增加。建议每当超说明书使用AAP时，确定复查日期，获得知情同意，并密切监测治疗情况和副作用。
