Newer anti-psychotic drugs are no safer than older ones for the risk of suddenly dying from a heart problem, says a study that finds they roughly double that hazard.
The older drugs had already been linked to an increased chance of sudden cardiac death, in which the heart loses its normal rhythm and can't pump blood normally.
The older and newer anti-psychotics had also been shown to boost the risk of death when used to treat agitation, aggression and delusions in elderly dementia patients. The new study was conducted among a much broader group of adults, with an average age of 46 and various psychiatric problems.
Anti-psychotic drugs are approved for treating schizophrenia and bipolar disorder, which is also called manic-depression, but doctors can legally prescribe them for any other use.
The new, federally funded study appears in Thursday's issue of the New England Journal of Medicine.
Researchers examined Tennessee Medicaid records covering the 15 years ending in 2005. They focused on about 44,000 users of older anti-psychotic drugs like haloperidol and about 46,000 users of newer drugs like Zyprexa, made by Indianapolis-based Eli Lilly & Co., and Risperdal, made by New Brunswick, N.J.-based Johnson & Johnson Inc.
The newer drugs have largely replaced the older medications in patient care.
The study also included 186,600 people who weren't taking anti-psychotics but resembled the users in age, heart risk status and other characteristics.
Some 1,900 participants died of sudden cardiac death over the 15 years. Analysis found that taking either the older or the newer drugs roughly doubled the risk of sudden cardiac death. The overall rate in drug users was about three deaths per year for every 1,000 patients.
"To me, three per thousand is frequent enough (that) I would take it into account for a family member or friend," said Wayne Ray of Vanderbilt University in Nashville, Tenn., a study author.
Ray stressed that patients should not simply stop taking the drugs, but should speak to their doctors. He noted that people with schizophrenia or a related psychosis have no real alternative to anti-psychotic drugs. Perhaps they should get heart examinations before going on the drugs, and take steps to reduce their risk of sudden cardiac death, he said.
There are alternatives for treating bipolar disorder, he said. And for other uses, anti-psychotics should be considered "a very last resort, to be used sparingly," he recommended.
In a journal editorial, Drs. Sebastian Schneeweiss and Jerry Avorn of Harvard Medical School said the study "makes a clear case" for increased risk of the heart problem from all anti-psychotics.