Atypical antipsychotic drugs for dementia may be associated with small increased ris...( urred more often among patients randomi...),Health

"These findings emphasize the need to consider certain changes in some clinical practices. Antipsychotic drugs have been dispensed fairly frequently to patients with dementia and used for long periods. The established risks for cerebrovascular adverse events together with the present observations suggest that antipsychotic drugs should be used with care in these patients. The fact that excess deaths and cerebrovascular adverse events can be observed within 10 to 12 weeks of initiating medication, coupled with observations from individual clinical trials results that there is substantial improvement in both drug and placebo groups during the first 1 to 4 weeks of treatment, lead to the consideration that antipsychotic drugs should be prescribed and dosage adjusted with the expectation of clinical improvement within that time. If improvement is not observed, the medication could be discontinued," the authors write.

"As a meta-analysis, our results should be taken as hypothesis-generating for an increased risk for deaths in patients with dementia receiving atypical antipsychotic drugs. No drug is individually responsible for the effect, but rather each contributes to the overall effect. This effect may not be limited to atypical drugs as a class and may be associated with haloperidol and other drugs that have not been subjected to efficacy trials in elderly patients with dementia," the researchers conclude.

(JAMA.2005; 294:1934-1943. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: For funding/support information and financial disclosures, please see the JAMA article.

Editorial: Antipsychotic Dr
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Contact: Jon Weiner
323-442-2823
JAMA and Archives Journals
18-Oct-2005