Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Antipsychotic safety in elderly dementia

The European Medicines Agency (EMEA) has completed a review (PDF) of the safety of conventional (typical) antipsychotics in elderly patients with dementia.

The available evidence suggests that conventional antipsychotics are likely to be associated with increased mortality and that the excess mortality observed may be greater than that observed for the newer atypical antipsychotics. These findings cannot be confirmed due to methodological limitations and no firm conclusions are available for differences in risk between individual antipsychotics. The increased risk is assumed to apply to all medicines in the class.

The review concludes that product information for the conventional antipsychotics should be updated to include information on the increased risk of mortality.

Clinicians are advised to follow national guidelines when treating dementia patients presenting with episodes of psychotic symptoms or aggressive behaviour including a discussion of the risks and benefits. Switching between atypical and conventional antipsychotics is not recommended.

Action: Clinicians who see elderly patients with dementia should be aware of this review and the implement these recommendations.

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