The misery to which I refer was caused by the wholesale withdrawal of the
stuff and changing people to what was it - promazine? TDZ now only used on
some sort of special arrangement by psychs ie not at all. And it turns out
lots of them have qt interval problems if you look hard enough. Drugs I mean
not patients.
--
Fay
----- Original Message -----
From: "Emile de Sousa" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, March 09, 2004 11:46 PM
Subject: Re: ATYPICAL ANTIPSYCHOTIC DRUGS AND STROKE
> Come on- thioridazine was and is an excellent drug at GP dosages. Cheap,
> effective and not especially toxic compared to say aspirin, atenolol or
> warfarin....
>
>
> > Remember thioridazine and the lives made miserable by that episode?
> > Chlorpromazine and haloperidol, those well-known side-effect -free
> > medicines, good grief!
> > --
> > Fay
> >
> > ----- Original Message -----
> > From: "Paul Caldwell" <[log in to unmask]>
> > To: <[log in to unmask]>
> > Sent: Tuesday, March 09, 2004 4:59 PM
> > Subject: Re: ATYPICAL ANTIPSYCHOTIC DRUGS AND STROKE
> >
> >
> > > 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/
> > >
> > >
>
>
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