Low dose antipsychotics in people with dementia

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Low dose antipsychotics in people with dementia
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Options for local implementation NPC. Key
therapeutic topics Medicines management options
for local implementation. Updated July 2011

• Review, and where appropriate revise, prescribing
  of low dose antipsychotics in people with
  dementia, in accordance with NICE-SCIE guidance
  and the NICE Quality Standard on dementia.

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Key questions

• What are the benefits and risks of prescribing
  antipsychotics for people with dementia?
• When is it appropriate to prescribe
  antipsychotics for people with dementia?
• What are the alternatives?
• What can I do to reduce the inappropriate
  prescribing of antipsychotics?

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The Banerjee report The use of antipsychotic
medication for people with dementia Time for
action. A report for the Minister of State for
Care Services. November 2009 MeReC Rapid Review
No. 847

• About 180,000 people with dementia treated with
  antipsychotic medication in England per year
• Of these, up to 36,000 may derive some benefit
  from treatment, but an additional 1,800 may die
  and an additional 1,620 suffer a cerebrovascular
  adverse event (around half of which may be
  severe) per year
• If support was available to provide alternative
  methods of managing behavioural problems,
  prescribing of antipsychotics could be reduced by
  up to two-thirds in people with dementia.

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NICE dementia quality standardwww.nice.org.uk/abo
utnice/qualitystandards/dementia/dementiaqualityst
andard.jsp
People with dementia who develop non-cognitive
symptoms that cause them significant distress, or
who develop behaviour that challenges, are
offered an assessment at an early opportunity to
establish generating and aggravating factors.
Interventions to improve such behaviour or
distress should be recorded in their care plan.
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c) Proportion of people with dementia with
mild-to-moderate non-cognitive symptoms who are
prescribed anti-psychotic medication. (Goal to be
0 .
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Drug interventions (1) NICE/SCIE clinical
guideline No 42. November 2006 (amended March
2011)

• People with dementia who develop non-cognitive
  symptoms or behaviour that challenges should be
  offered a pharmacological intervention in the
  first instance only if they are severely
  distressed or there is an immediate risk of harm
  to the person or others.
• Choose antipsychotic after an individual
  riskbenefit analysis.
• Start on low dose and then titrate upwards.
• Limit treatment time and review regularly (at
  least every 3 months or according to clinical
  need).

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Drug interventions (2) NICE/SCIE clinical
guideline No 42. November 2006 (amended March
2011)

• For less severe distress and/or agitation,
  initially use a non-drug option
• Do not use antipsychotic drugs for mild to
  moderate non-cognitive symptoms in
• Alzheimers disease, vascular dementia or mixed
  dementia, because of the risk of cerebrovascular
  events and death
• Dementia with Lewy bodies because of the risk of
  severe adverse reactions

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NPC patient decision aidwww.npc.nhs.uk/therapeuti
cs/cns/dementia/resources/pda_dementia_antipsychot
ics.pdf
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Call to actionDH. Call to action on the use of
antipsychotic drugs for people with dementia.
June 2011
All people with dementia who are receiving
antipsychotic drugs should receive a clinical
review from their doctor to ensure that their
care is compliant with current best practice and
guidelines, and that alternatives to medication
have been considered by 31 March 2012
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Key messages

• Antipsychotics are over-prescribed for the
  treatment of behavioural and psychological
  symptoms of dementia
• Benefits are limited, and these drugs increase
  the risk of death and cerebrovascular events
• Follow NICE/SCIE guideline for dementia
• People with dementia who develop non-cognitive
  symptoms or behaviour that challenges should be
  offered a pharmacological intervention in the
  first instance only if they are severely
  distressed or there is an immediate risk of harm
  to the person or others
• Prescribing of antipsychotics could be reduced by
  up to two-thirds in people with dementia if
  support was available to provide alternative
  methods of managing behavioural problems

These slides should be used in conjunction with
the accompanying notes