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
>
> _________________________________________________________________
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