Black box warning

However, it comes at the price of over 90% rate of toxicity.

It featured sedation, I think, appropriately, but falls, metabolic disturbance, Parkinsonian features, peripheral edema, marked confusion, even death in unexpected stroke, leading to this boxed warning for the entire class when used in the elderly.

18% efficacy and 90% toxicity is not a good formula.

There's a saying in geriatric psychiatry that you get painted into the corner.

But I really want to get into now the idea of older versus newer.

And those are in air quotes, right? Older versus newer.

You referenced earlier the boxed warning that these older medications have became a class effect.

And the FDA brought together a panel of experts in 2024 to take another look at the mortality risk behind the boxed warning.