The Pharmaceutical Journal
Vol 278 No 7433 p11
6 January 2007

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• Patient safety
• MURs
• Section 60 Order (3)
• The Society
• Wholesaling

Letters to the Editor

Patient safety

Use of antipsychotic medicines in Alzheimer’s disease

From Mr R. Lyon, MRPharmS

After reading the article, “Understanding Alzheimer’s disease” (PJ, 25 November 2006, pp643–6), I was concerned that the advice given in the second last section, entitled “Behavioural and psychiatric problems”, might encourage the inappropriate use of antipsychotics.

The third paragraph on psychotic symptoms advocates atypical antipsychotics as first-line. No reference is made anywhere in the article about the Committee on Safety of Medicines warning in 2004 to avoid risperidone and olanzapine in patients with dementia because of the increased risk of strokes.

Our trust advises trying non-pharmacological interventions first-line and the use of any antipsychotic with great caution since the problems associated with risperidone and olanzapine may also apply to other antipsychotics, only the studies have not been done.

I would only advocate the use of antipsychotics if all the potential risks had been explained to the patient or carers and the discussions documented. I would then use the lowest possible dose with regular reviews.

Ray Lyon
Chief Pharmacist
Sussex Partnership NHS Trust

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