How safe are antipsychotics in dementia?

doi:10.1136/dtb.2007.10.0002

Drug and Therapeutics Bulletin 2007;45:81-85; doi:10.1136/dtb.2007.10.0002

How safe are antipsychotics in dementia?

Around 800,000 people in the UK have dementia, about 80% ofwhom will have behavioural changes or psychological symptomsin the course of the illness.¹ Such features lower quality oflife for both patients and carers, and often result in transferto residential care and higher costs.² ³ ⁴ ⁵ Currently, no drugs are licensed in the UK specificallyfor behavioural changes and psychological symptoms in patientswith dementia. Nevertheless, antipsychotic medications havebeen used in people with dementia, both for psychotic symptomsand also for less specific problems such as agitation and aggression.There have been long-standing concerns about the inappropriateuse of these drugs in such settings.⁶ In 2004, following worriesover an increased likelihood of stroke with risperidone andolanzapine, the former UK Committee on Safety of Medicines (CSM)advised that these drugs "should not be used for the treatmentof behavioural symptoms of dementia".⁷ However, this led toreports of unsuitable interpretation of the guidance, with groupsof patients having their medication withdrawn inappropriatelyor being switched to other, potentially more harmful, drugs.⁶Here we assess the safety of antipsychotic medication in peoplewith dementia.