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All Antipsychotic Drugs Pose Stroke Risk

Aug 29, 2008 | Parker Waichman LLP

United Kingdom researchers report that more people than was at first believed could be at a higher risk of suffering a stroke due to antipsychotic drugs.  Earlier research only pointed to some types of the drug as increasing the risk, especially for those diagnosed with dementia.  Now, a study published in the British Medical Journal says all forms of antipsychotic drugs increase stroke risk and this increase occurs in all patients.

Typically, antipsychotics are prescribed to control psychotic symptoms in patients with schizophrenia and some severe forms of depression.  Atypically, antipsychotic drugs are believed to be widely used to control some dementia symptoms, such as aggression; many experts disagree on this use.  Anitpsychotics are characterized into two categories:  The newer "atypical" - including Zyprexa, Seroquel and Risperdal -  and the older "typical" antipsychotics.  In 2002, when concerns were raised over antipsychotic use, the focus was on "atypicals,” which led to a recommendation from drug safety advocates in the United Kingdom that such drugs should not be prescribed to dementia patients.  The UK government has been urged to strengthen this suggestion when completing its pending dementia strategy.

The first anti-psychotics, like Thorazine, helped many but came with severe side effects, such as tardive dyskinesia and involuntary and debilitating movements.  The second generation, dubbed atypicals, emerged in the 1990s and cause fewer involuntary movements, but weight gain and diabetes can result, said Tom Clark, clinical affairs director for the American Society of Consultant Pharmacists Foundation.

These newest findings—released from researchers at the London School of Hygiene and Tropical Medicine---confirm fears long associated with the treatment of dementia patients, but also raise broader issues.  For instance, the researchers identified 6,700 patients with an average age of 80 and found a greater than three-fold risk for dementia patients suffering stroke while taking any sort of anti-psychotic drug.  Patients without dementia taking any sort of antipsychotic realized a 40% increase in risk.

The researchers repeated the recommendation that patients with dementia should not be prescribed these drugs. "The over-prescription of antipsychotics is a serious breach of human rights, these drugs should only be a last resort,” said Neil Hunt, from the Alzheimer's Society and that doctors must now pay attention to these warnings.  "The forthcoming National Dementia Strategy is a crucial opportunity to stop this dangerous over-prescribing and we look forward to its launch in the autumn."  Meanwhile, Marjorie Wallace, the chief executive of the mental health charity Sane, said that while the drugs were capable of transforming lives, different patients reacted differently to their side-effects, "This study should remind us all that antipsychotics are powerful drugs which can both be essential for some people, while carrying other risks.  This is another warning that all antipsychotics should be prescribed with great thought and care and be subject to rigorous follow-up."

In the United States, over 26 percent of the nation's nursing home residents were on antipsychotics in early 2007, compared with 19.4 percent in 1999, federal surveys show.  Those drugs do little to help dementia patients, said Lon S. Schneider, a California psychiatrist and lead investigator of the CATIE-AD study of outpatients with Alzheimer's.  He and his colleagues found that patients on anti-psychotics for 12 weeks had a slightly greater risk of dying sooner than those on placebo.


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