Doctors are being urged to reduce prescribing antipsychotics to dementia patients after the largest study of its kind found they were linked to more harmful side effects than previously thought.
The powerful medication is widely prescribed for behavioral and psychological symptoms of dementia such as apathy, depression, aggression, anxiety, irritability, delirium and psychosis. Tens of thousands of dementia patients in England they are prescribed every year.
Safety concerns have previously been raised about the drugs, with warnings to medics based on increased risks of stroke and death, but evidence of other dangers has been less conclusive.
New research suggests that there is a significantly greater range of harms associated with its use than previously recognized in regulatory warnings, underscoring the need for greater caution in the early stages of treatment.
Antipsychotic use in dementia patients was associated with increased risks of a wide range of serious adverse outcomes, including stroke, blood clots, heart attack, heart failure, fracture, pneumonia and acute kidney injury, the study’s authors reported. Their findings were published in the BMJ.
Charles Marshall, a professor of clinical neurology at Queen Mary University of London, who was not involved in the study, said: “This evidence should prompt renewed efforts to reduce the prescribing of antipsychotics to people living with dementia. reduce.
“There are rare circumstances where antipsychotics are truly needed, and the benefits outweigh these risks, but for the majority of patients with behavioral symptoms that could lead to antipsychotics being prescribed, we need to focus on much safer behavioral management approaches.”
The study examined data from 174,000 adults registered at GP surgeries in England who were diagnosed with dementia between 1998 and 2018.
During the study, 35,339 antipsychotics were prescribed – of whom 63% were women – and their medical records were compared with those of dementia patients who were not prescribed these drugs.
Academics from the universities of Manchester, Nottingham, Edinburgh and Dundee found that dementia patients who took antipsychotic drugs had a two-fold increased risk of developing pneumonia compared to those who did not.
Researchers also found that dementia patients who used antipsychotics had a 61% increased risk of stroke and a 43% increased risk of breaking a bone. There was also a 28% increased risk of heart attack and 27% increased risk of heart failure.
Patients with dementia prescribed antipsychotics had a 72% increased risk of kidney injury and a 62% increased risk of developing a type of blood clot called a venous thromboembolism. The increased risks appear to be highest in the first week after treatment.
The study was observational, so no firm conclusions could be drawn about cause and effect. But the authors wrote: “The range of adverse outcomes was wider than previously highlighted in regulatory warnings, with the highest risks shortly after initiation of treatment.”
Prof Darren Ashcroft, the study’s senior author, from the University of Manchester, said: “In recent years it has become clear that more people with dementia are being prescribed antipsychotic drugs, despite existing regulatory safety warnings.
“It is important that any potential benefits of antipsychotic treatment are carefully weighed against the risk of serious harm, and treatment plans should be regularly reviewed in all health and care settings.”
Commenting on the study, Dr Sheona Scales, the director of research at the charity Alzheimer’s Research UK, said the findings suggested the risks could be more serious than previously understood, which was “particularly worrying given the increase in its use during the pandemic”.
Dr Tom Russ, an honorary consultant psychiatrist at the University of Edinburgh, added: “This study does not suggest to me that this medication should never be used, but that it should be used sparingly in situations where other avenues have been explored .”
