Antipsychotics for dementia raise ‘risk of serious harm’: Study

GPs are being urged to use increased caution in the early stages of prescribing dementia patients antipsychotics, with a study finding potential benefits must be ‘weighed against risk of serious harm’.
 
The 20-year investigation involved more than 170,000 English patients, all with a dementia diagnosis, and concluded antipsychotic use is associated with elevated risks of a wide range of serious adverse outcomes.
 
Published in the British Medical Journal, the study concluded that when compared with non-use, antipsychotics are associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury.
 
‘The effect of antipsychotics on behavioural and psychological symptoms of dementia is modest at best, but the proportion of people with dementia prescribed antipsychotics has increased in recent years,’ researchers said.
 
‘Increased priority on more patient-centric care, tailored care plans, regular reassessment of management options, and a move away from the overprescription of antipsychotics is overdue.’
 
Of the 170,000 patients analysed for the study, 35,000 were prescribed an antipsychotic on or after the date of their dementia diagnosis including risperidone, quetiapine, haloperidol, and olanzapine.
 
In the first three months, rates of pneumonia among antipsychotic users were 4.48% compared to 1.49% for non-users, and at one year it rose to 10.41% versus 5.63%.
 
There was a 1.7-fold increased risk for acute kidney injury, and a 1.6-fold increased risk for stroke and venous thromboembolism when patients were taking antipsychotics.
 
Additionally, risks were highest during the first week of antipsychotic treatment, especially for pneumonia.
 
Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, told newsGP the potential for adverse effects from antipsychotic use is well established, saying the treatment should not be used as a single solution.
 
‘With all medical treatments, risks must be weighed against benefits and an informed decision must be made,’ he said.
 
‘Antipsychotic use must never be “set and forget” but must be regularly reviewed with consideration for deprescribing where appropriate and possible.
 
‘Chemical restraints, which can include antipsychotics, in the management of people living with dementia and experiencing Behavioural and Psychological Symptoms of Dementia [BPSD], should only ever be used as a single part of a comprehensive, multidisciplinary Behavioural Support Plan, which include non-pharmacological interventions.’
 
According to the latest Australian data, antipsychotic medications are dispensed to around 20% of the 68,700 people who have scripts dispensed for dementia-specific medication.
 
Around 36% of these were for risperidone, followed by quetiapine (30%) and olanzapine (25%).
 
However, Dr Marinucci urged caution when interpreting the study’s results, saying its basis in England could produce different results when compared to Australian patients.
 
‘This study type cannot reveal any causation, only trends and association which are open to bias and confounding factors,’ he said.
 
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