also seen the companies messages to GPs. This really will hit those drug
reps and EMI teams who have been ramming these drugs down our throats over
the last 5 years. So, back to chlorpromazine and haloperidol?
>From: Jeff Green <[log in to unmask]>
>Reply-To: GP-UK <[log in to unmask]>
>To: [log in to unmask]
>Subject: ATYPICAL ANTIPSYCHOTIC DRUGS AND STROKE
>Date: Tue, 9 Mar 2004 16:27:49 -0000
>
>-------------------------------------------
>To: [log in to unmask]
>Subject: Public Health Link: ATYPICAL ANTIPSYCHOTIC DRUGS AND STROKE
>[URGENT
>(cascade within 24 hours)]
>Importance: High
>
>
>Cascade Codes: #COMMUNITYPHARMACISTS##GP#
>
>
>To: NHS Trusts - Medical Directors (England)
> Primary Care Trusts - Directors of Public Health
> Primary Care Trusts - Medical Directors
> Public Health Link
>
>Cc: Chairman - Professional Executive Committee of PCT
> MHRA Drug Alerts
> Regional Directors of Public Health
> Strategic Health Authorities (England) - Directors of Public
>Health
> Territorial CMOs
>
>From: Professor Gordon Duff - Chairman of Committee on Safety of
>Medicines
>Date: 8 March 2004
>Reference: CEM/CMO/2004/1
>
>Category: URGENT (cascade within 24 hours)
>
>Title: ATYPICAL ANTIPSYCHOTIC DRUGS AND STROKE
>
>
>
>
>----------------------------------------------------------------------------
>---------------
>
> PUBLIC HEALTH LINK
>
>To: Directors of Public Health of PCTs to forward to:
>
>- All GENERAL PRACTITIONERS - please ensure this message is seen by all
>practice nurses and non-principals working in your practice and retain a
>copy in your `locum information pack'.
>- Deputising services
>- Project manager/Nurse lead in Walk in Centres
>- Lead nurses in PCTs
>- Leads at nurse-led PMS Pilots
>- PCT Pharmaceutical Advisers to forward to community pharmacists
>- PCT Prescribing Advisers
>
>To: Medical Directors of NHS Trusts to forward to:
>
>- Consultant Psychiatrists
>- Nurse Executive Directors of NHS Trusts
>- Trust Chief Pharmacists to forward to Medicines Information Pharmacists
>
>Cc:
>- Regional Directors of Public Health
>- Directors of Public Health of Strategic Health Authorities to forward to
>SHA pharmaceutical advisers and SHA lead nurses
>- UK CMOs
>- Chairmen of Professional Executive Committee
>
>Dear Colleague,
>
> ATYPICAL ANTIPSYCHOTIC DRUGS AND STROKE
>
>I am writing to inform you of an important concern about the safety of
>atypical antipsychotic drugs and provide new prescribing recommendations.
>Evidence reviewed by the Committee on Safety of Medicines (CSM) indicates
>an
>increased risk of stroke which particularly applies when these drugs are
>used by elderly patients with dementia.
>
>Background
>
>Although no atypical antipsychotic drug is licensed for the treatment of
>behavioural disturbance in dementia, they are quite frequently used for
>this
>purpose and manufacturers have conducted clinical trials in this
>indication.
>The Committee has reviewed the available data from trials of risperidone
>and
>olanzapine and considered other relevant evidence.
>
>Relevant evidence
>
>Risperidone is the most extensively studied drug in this context and a
>meta-analysis of randomized placebo-controlled clinical trials in elderly
>patients with dementia has shown that, compared with placebo, the risk of
>stroke with risperidone was approximately three times higher.
>
>A pooled analysis of randomized placebo-controlled clinical trials of
>olanzapine in elderly patients with dementia has shown a similar increased
>risk of stroke and a 2-fold increase in all-cause mortality.
>
>The mechanism by which these drugs are associated with stroke is unclear.
>Although some patients with dementia may have underlying vascular disease,
>the risk is not confined to this group. Although most of the evidence
>causing concern comes from patients with dementia, the risk may not be
>confined to use in this indication and should be considered relevant to any
>patient with a history of cerebrovascular disease or relevant risk factors
>(see below).
>
>CSM advice on balance of risks and benefits
>
>The CSM has advised that there is clear evidence of an increased risk of
>stroke in elderly patients with dementia who are treated with risperidone
>or
>olanzapine. The magnitude of this risk is sufficient to outweigh likely
>benefits in the treatment of behavioural disturbances associated with
>dementia and is a cause for concern in any patient with a high baseline
>risk
>of stroke.
>
>Prescribing advice
>
>- CSM has advised that risperidone or olanzapine should not be used for
>the treatment of behavioural symptoms of dementia.
>
>- Use of risperidone for the management of acute psychotic conditions in
>elderly patients who also have dementia should be limited to short-term and
>should be under specialist advice (olanzapine is not licensed for
>management
>of acute psychoses).
>
>- Prescribers should consider carefully the risk of cerebrovascular
>events before treating any patient with a previous history of stroke or
>transient ischaemic attack. Consideration should also be given to other
>risk
>factors for cerebrovascular disease including hypertension, diabetes,
>current smoking and atrial fibrillation.
>
>Although there is presently insufficient evidence to include other
>antipsychotics in these recommendations, prescribers should bear in mind
>that a risk of stroke cannot be excluded, pending the availability of
>further evidence. Studies to investigate this are being initiated.
>
>Patients with dementia who are currently treated with an atypical
>antipsychotic drug should have their treatment reviewed. Many patients with
>dementia who are disturbed may be managed without medicines. Treatment
>guidelines are available at websites listed below.
>
>Product information
>
>Prescribing information for risperidone and olanzapine are being amended to
>reflect the advice given above.
>
>Further information (available from 1pm Tuesday 9 March)
>
>Treatment guidelines are available at the following websites:
>http://www.rcpsych.ac.uk/college/faculty/oap/professional/index.htm
>http://www.rcgp.org.uk/corporate/position/drugs.asp
>http://www.bgs.org.uk/
>
>Information for patients and carers is available at the following website:
>http://www.alzheimers.org.uk
>
>Further information about the CSM advice can be found on the Medicines and
>Healthcare products Regulatory Agency (MHRA) website:
>
>http://www.mhra.gov.uk
>
>For any additional information please phone the MHRA on 020 7084 2000.
>
>Professor Gordon Duff
>Chairman ? Committee on Safety of Medicines
_________________________________________________________________
Fast. Reliable. Get MSN 9 Dial-up - 3 months for the price of 1!
(Limited-time Offer) http://click.atdmt.com/AVE/go/onm00200361ave/direct/01/
|