gms | German Medical Science

Background: Neuroleptics (NLs) are frequently used in elderly patients. We aimed to assess characteristics and drug use patterns of elderly users of specific NL classes and individual NLs in Germany.

Materials and Methods: We conducted a cohort study in the German Pharmacoepidemiological Research Database (GePaRD) and identified all persons aged 65 years and older with a NL dispensation between 2005 and 2009. Co-morbidity and co-medication was assessed and we obtained the percentage of concurrent users of two or more NLs, of switchers to other NLs and of treatment discontinuation among users of NL drug classes and individual NLs. In addition, we calculated the median duration of NL treatment. In subgroup analyses these measures were also calculated for NL users with dementia and psychoses.

Results: Overall, 302,998 persons received at least one NL. The median age at cohort entry was 77 years and 69% were female. 67% entered the cohort with a conventional NL, 30% with an atypical NL and 2% with both classes. Among individual NLs, melperone most often led to cohort entry (22%), followed by promethazine (16%), sulpiride (12%) and risperidone (10%). The median treatment duration for any NL was 22 days and varied between NL classes and individual drugs. Only 9% of all NL users were identified as concurrent user or switcher and 28% of patients had discontinued treatment. Patients with dementia were older (median 82 years) and had shorter treatment duration (median 20 days) whereas patients with psychoses were younger (median 73 years) and treated longer (median 51 days). Switch and concurrent use of different NLs was most common in patients with psychoses (7% and 18%, respectively).

Conclusion: Characteristics and drug use patterns of specific NL classes and individual NLs assessed in a large cohort of elderly Germans varied substantially, especially between NL users with dementia and psychoses.