Deadline for GPs to get elderly off neuroleptics
GPs are being ordered by the Government to take nearly 40,000 elderly patients with dementia off two atypical
All older patients with dementia prescribed risperidone or olanzapine for behavioural problems must have their treatment reviewed within the next few weeks, the Committee on Safety of Medicines ruled.
The CSM issued the advice after reviewing evidence that showed a threefold increase in the risk of stroke for elderly patients with dementia taking risperidone and a similar risk with olanzapine.
Both drugs are licensed to treat acute psychosis and schizophrenia but are often prescribed off label to treat
behavioural problems in older people with dementia.
Clinical trials show some evidence of benefit to patients and last year about 30,000 patients aged 65 and over received risperidone and 9,000 were prescribed olanzapine.
But prescribing experts urged GPs to reassure patients taking the drugs for other conditions.
Dr Peter Fellows, GPC prescribing spokesperson, said the drugs were 'vitally important' as antipsychotics and improved schizophrenia patients' quality of life.
'What we don't want to do is frighten people who have serious psychosis into stopping their medication,' he said.
The Government is currently drawing up new guidelines on alternative ways of managing behavioural problems in older patients with dementia, but Sir Alasdair Breckenridge, chair of the Med- icines and Healthcare Products Regulatory Agency, said many such patients could be treated without medicines. 'For those who do need drug treatment there are a variety of alternatives available,' he said.
Three years ago the CSM banned the use of another
antipsychotic, thioridazine, in calming patients with dementia after evidence showed it could cause serious cardiotoxicity.
Dr Jim Kennedy, RCGP prescribing spokesperson, said: 'This emphasises the fact that very few elderly people should be on these drugs and that the manner in which they are nursed is crucial to managing their behavioural problems.
'We have got to try to concentrate on behavioural management systems rather than drugs,' he added.
By Cato Pedder