- Children and young adults without psychosis receiving chlorpromazine-equivalent doses >50 mg have significantly increased risk for unexpected death.
- These higher doses were specifically associated with increased risk for death from metabolic or cardiovascular (CV) causes.
Why this matters
- Antipsychotics are used for many reasons among children beyond an indication for psychosis.
- Editorial: The results “heighten the already increased caution about prescribing antipsychotics to children and adolescents.”
- With higher antipsychotic dose vs control, unexpected deaths were 76.8 per 100,000 person-years vs 17.9 per 100,000 person-years.
- Adjusted HRs (95% CIs) were:
- All deaths: 1.80 (1.06-3.07).
- Deaths from suicide or accidental injury: 1.03 (0.53-2.01).
- Unexpected deaths: 3.51 (1.54-7.96).
- Unexpected deaths from CV/metabolic causes: 4.29 (1.33-13.89).
- Retrospective cohort study, Tennessee Medicaid enrollees, ages 5-24 years (30,120 high-dose group; 28,377 low-dose group; 189,361 controls [other types of medications]), 1999-2014, without severe somatic illness, schizophrenia/psychoses, Tourette, chronic tic disorder.
- Outcome: death, including unexpected death from CV causes.
- Funding: NIH.
- Possible uncontrolled confounding.
- Patient factors such as BMI not known.