CSM warning on atypical psychotics and stroke may be detrimental for dementia

EDITOR-On 9 March the Committee on Safety of Medicines (CSM) advised avoiding olanzapine and risperidone for patients with dementia, reflecting concern over the excess risk of stroke. 1 Antipsychotic drugs have long been used (off licence) in dementia to treat neuropsychiatric disturbance and are highly effective. 2 Atypical antipsychotic drugs have recently been favoured over older preparations to avoid anticholinergic and Parkinsonian side effects, but a recent study of elderly people receiving typical and atypical antipsychotic drugs found no significant difference in risk of stroke between pharmacological groups. 3 Stroke, while potentially catastrophic, is a quantifiably rare "excess risk" event in a group already at risk, demanding balanced thinking against real reductions in agitation and aggression. 4 We are concerned that antipsychotic treatment will be unnecessarily withheld, and also that general practitioners will now adopt widespread use of conventional antipsychotic drugs.