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Stroke risk from antipsychotics highest in dementia patients

All antipsychotic drugs increase the risk of stroke, with the risk particularly high in patients with dementia, a new primary care study shows.

Overall, use of any class of antipsychotic raise the risk of stroke by 73%, and by more than three-fold in patients with a diagnosis of dementia – a finding described by GPs as a ‘wake-up call'.

While previous research has shown second generation, or atypical, antipsychotic drugs could increase the risk of stroke, there was little information on the risk with first generation drugs, or in dementia.

But the new study, of records from more than 6,000 patients on the UK general practice research database, found the risk of stroke in the overall patient population was increased by 1.69-fold by typical antipsychotics and 2.3-fold with atypical drugs.

Patients without dementia had a modest increase in risk, of just 41% with any class of antipsychotic drug, but the risk was increased 3.5-fold in dementia.

The researchers said their findings clarified the risks of stroke associated with antipsychotics – and highlighted the fact that a risk existing for older as well as newer drugs.

They added that their findings were particularly important for treatment of dementia.

Study leader Dr Ian Douglas, a research fellow at the London School of Hygiene and Tropical Medicine, said: ‘We reaffirm the risks associated with antipsychotic use in patients with dementia generally outweigh the potential benefits, and in this patient group, use of antipsychotic drugs should be avoided wherever possible.'

Dr Ian Walton, a GP in Tipton in the West Midlands and chair of Primary Care Mental Health and Education, said it was time GPs looked for alternatives to antipsychotics in their dementia patients.

‘This should be a wake-up call. There's a huge amount of work to be don to look at how we do treat people with dementia non-pharmacologically. If you have a behavioural approach you can keep the prescribing of antipsychotics right down.'

Dr Brian Crichton, a GP in Solihull, Birmingham and a lecturer in therapeutics and pharmacology at the University of Warwick, said: ‘In my patients with dementia we have reduced our prescribing of antipsychotics and I think this study will further support the way our prescribing patterns have changed.'

Antipsychotics and risk of stroke

(figures are rate ratios)

1.73 - use of any antipsychotic drug
1.69 - use of typical antipsychotics
2.32 - use of atypical antipsychotics
3.5 - use of any antipsychotic in patients with dementia
1.41 - use of any antipsychotic in patients without dementia

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