Practitioner 2009;253(1715):10-11

Antipsychotics should be used with caution in dementia

29 Mar 2009Pais-up subscribers

A randomised, placebo-controlled discontinuation trial from the UK has found an increased long-term risk of mortality in those patients with dementia who remained on antipsychotic medication. A total of 165 patients were recruited, of whom 37 withdrew prior to the onset of the 12-month trial period. Of the remaining 128 patients, 64 continued to receive antipsychotic medication and 64 were given a placebo. Most of the patients were prescribed risperidone (67%) or haloperidol (26%) before randomisation. Commenting on the study, Dr Phillip Bland,GP, Dalton-in-Furness, writes, 'The CSM has advised that the risk of stroke is three times higher with risperidone and olanzapine and that they should not be used to treat behavioural symptoms in dementia. The present study, however, did not find evidence of an increase in cerebrovascular deaths. There are several other potential causes of death in patients taking antipsychotics, including arrhythmias, aspiration pneumonia, thromboembolism and falls. All atypical antipsychotics are associated with an increased risk, and the risk is greater for conventional antipsychotics.' He concludes, 'This trial provides a further reminder that we should regularly review our patients with dementia and seek to withdraw antipsychotic medication at the earliest opportunity.'

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