Off-label use of antipsychotics common among older adults in Finland
The study utilised national registry data on 209,346 older adults living at home, who did not have Alzheimer’s disease. Background factors and morbidity related to antipsychotic use were examined across three groups: off-label users, those prescribed antipsychotics for an official indication (on-label), and people not using antipsychotic medications.
The results showed that 70 per cent of all antipsychotic use was off-label. Off-label use also increased towards the end of the follow-up period. The most commonly used antipsychotics off-label were risperidone and quetiapine.
Antipsychotics are prescribed to older patients, for example, to treat prolonged behavioural symptoms or insomnia, although there are no official indications for such uses. In the literature, this type of use without appropriate non-pharmacological or other treatment options has even been considered a form of elder abuse. At the same time, the reduction of resources in elderly care services and the limited availability of non-drug interventions have contributed to increased medication use.
Cardiovascular and cerebrovascular conditions prominent among off-label users
The study found that off-label users more often had cardiovascular diseases and cerebrovascular disorders compared with the other groups. They also had higher opioid use.
“Surprisingly, off-label users had cardiovascular and cerebrovascular conditions even more frequently than patients prescribed antipsychotics for an official indication, such as psychotic disorders,” says Postdoctoral Researcher Tuomas Majuri from the University of Oulu.
According to Majuri, this finding may reflect that monitoring of the metabolic side effects of medications is currently insufficient in off-label use.
The researchers emphasise that the results highlight the need to develop alternative treatment options for symptoms and situations for which antipsychotics are currently used off-label.
“Clearer guidelines are needed for monitoring the metabolic side effects of off-label antipsychotic use, as well as measures to promote safer prescribing practices,” Majuri stresses.
The study was funded by the Päivikki and Sakari Sohlberg Foundation and the Research Council of Finland.
Study publication:
Majuri T*, Silvan J*, Tolppanen A-M, Hartikainen S, Huotari T, Rautio N, Miettunen J, Nordström T, Jääskeläinen E, Haapea M. Characteristics and predictors of antipsychotic medication off-label use among community-dwelling older people. Nord J Psychiatry 2026. Published online 16 Feb 2026.