4: Central nervous system

Please select a topic:

4.1 Hypnotics and anxiolytics / 4.2 Drugs used in psychoses and related disorders
4.3 Antidepressant drugs / 4.4 Central nervous system stimulants
4.5 Drugs used in obesity
4.6 Drugs used in nausea and vertigo / 4.7 Analgesics
4.8 Antiepileptics / 4.9 Drugs used in parkinsonism and related disorders
4.10 Drugs used in substance dependence / 4.11 Drugs for dementia

Changes to the Formulary since previous version

(19.7.2013)

Section / Change / Reason for change
4.8 / ADDED: Buccolam® / Gateshead Medicines Management Committee approval
4.6 / ADDED: Metoclopramide: risk of neurological adverse effects – restricted dose and duration of use / MHRA Drug Safety Alert

4. Antidepressants - swapping and stopping

General Guidelines

  • All antidepressants have the potential to cause withdrawal phenomena. When taken continuously for six weeks or longer, antidepressants should not be stopped abruptly unless a serious adverse event has occurred (e.g. cardiac arrhythmia with a tricyclic).
  • When swapping from one antidepressant to another, abrupt withdrawal should usually be avoided. Cross-tapering is preferred, where the dose of the ineffective or poorly tolerated drug is slowly reduced while the new drug is slowly introduced.
  • The speed of cross-tapering is best judged by monitoring patient tolerability. No clear guidelines are available, so caution is required.
  • Note that the co-administration of some antidepressants is absolutely contra-indicated, and even cross-tapering of small doses can be dangerous. In other cases, theoretical risks or lack of experience preclude recommending cross-tapering.
  • In some cases cross-tapering may not be considered necessary. An example is when switching from one SSRI to another: their effects are so similar that administration of the second drug is likely to ameliorate withdrawal effects of the first. However, there is little firm evidence of this occurring.
  • Potential dangers of simultaneously administering two antidepressants include pharmacodynamic interactions (serotonin syndrome, hypotension, drowsiness) and pharmacokinetic interactions (e.g. elevation of tricyclic plasma levels by some SSRIs). The serotonin syndrome may include restlessness, diaphoresis, tremor, shivering, myoclonus, confusion, convulsions and death.

The advice given in the following table should be treated with caution and patients should be very carefully monitored when switching.

ANTIDEPRESSANTS – SWAPPING AND STOPPING

To
From / MAOIs-
hydrazines / Tranyl-cypromine / Tricyclics / Citalopram /
Escitalopram / Fluoxetine / Paroxetine
MAOIs-
hydrazines / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks
Tranyl-
cypromine / Withdraw and wait for two weeks / - / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks
Tricyclics / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Cross taper cautiously / Halve dose and add citalopram then slow withdrawal.*2 / Halve dose and add fluoxetine then slow withdrawal.*2 / Halve dose and add paroxetine then slow withdrawal.*2
Citalopram/
Escitalopram / Withdraw and wait for one week / Withdraw and wait for one week / Cross taper cautiously *2 / - / Withdraw then start fluoxetine 10mg/day / Withdraw and start paroxetine at 10mg/day
Paroxetine / Withdraw and wait for two weeks / Withdraw and wait for one week / Cross taper cautiously with very low dose of tricyclic *2 / Withdraw and start citalopram at 10mg/day / Withdraw then start fluoxetine at 10mg/day / -
Fluoxetine*3 / Withdraw and wait five to six weeks / Withdraw and wait five to six weeks / Stop fluoxetine. Wait 4-7days. Start tricyclic at very low dose and increase very slowly / Stop fluoxetine. Wait 4-7 days. Start citalopram at 10mg/day and increase slowly / - / Stop fluoxetine. Wait 4-7 days, then start paroxetine 10mg/day
Sertraline / Withdraw and wait for one week1 / Withdraw and wait for one week / Cross taper cautiously with very low dose of tricyclic *2 / Withdraw then start citalopram at 10mg/day / Withdraw then start fluoxetine at 10mg/day / Withdraw then start paroxetine at 10mg/day

Red = Hospital use only

Green = GP & Hospital use. Drugs not classified as Red, Amber or Green + are classified as Green by default

Amber 1 = Drugs with shared care agreement

Green + = Initiated by Hospital specialist only

Gateshead Health NHS Foundation Trust Page 1 of 42 Date: 22.8.2013

Drug Formulary

To
From / Sertraline / Trazodone / Moclobemide / Reboxetine / Venlafaxine / Mirtazapine / Duloxetine
MAOIs-
hydrazines / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks*1 / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks
Tranyl-
cypromine / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks *1 / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw and wait for two weeks
Tricyclics / Halve dose and add sertraline then slow withdrawal.*2 / Halve dose and add trazodone then slow withdrawal. / Withdraw and wait for one week / Cross taper cautiously / Cross taper cautiously, starting with venlafaxine 37.5mg/day / Cross taper cautiously / Cross taper cautiously, starting with duloxetine 30mg per day. Increasing slowly
Citalopram/
Escitalopram / Withdraw and start sertraline at 25mg/day / Withdraw before starting titration of trazodone / Withdraw and wait at least one week / Cross taper cautiously / Withdraw. Start venlafaxine 37.5mg/day. Increase very slowly / Cross taper cautiously / Abrupt switch possible.Start duloxetine at 60mg per day.
Paroxetine / Withdraw and start sertraline at 25mg/day / Withdraw before starting titration of trazodone / Withdraw and wait at least two weeks / Cross taper cautiously / Withdraw paroxetine. Start venlafaxine 37.5mg/day and increase very slowly / Cross taper cautiously / Abrupt switch possible.Start duloxetine at 60mg per day.
Fluoxetine*3 / Stop fluoxetine. Wait 4-7 days, then start sertraline 25mg/day / Stop fluoxetine. Wait 4-7 days, then start low dose trazodone / Withdraw and wait at least five weeks / Cross taper cautiously / Withdraw. Wait 4-7 days. Start venlafaxine at 37.5mg/day. Increase very slowly / Cross taper cautiously / Abrupt switch possible.Start duloxetine at 60mg per day.
Sertraline / - / Withdraw before starting trazodone / Withdraw and wait at least one week / Cross taper cautiously / Withdraw. Start venlafaxine at 37.5mg/day.
Increase V slowly / Cross taper cautiously / Abrupt switch possible.Start duloxetine at 60mg per day.

*1. Abrupt switching is possible but not recommended.

*2. Do not co-administer clomipramine and SSRIs or venlafaxine. Withdraw clomipramine before starting.

*3. Beware interactions with fluoxetine may still occur for five weeks after stopping fluoxetine because of long half-life.

*5. Withdrawal effects seem to be more pronounced. Slow withdrawal over 1-3 months may be necessary.

Adapted from: Taylor D, Paton C, and Kapur S. The Maudsley Prescribing Guidelines, 11th ed. London: Informa Healthcare, 2012

To
From / MAOIs-
hydrazines / Tranyl-cypromine / Tricyclics / Citalopram /Escitalopram / Fluoxetine / Paroxetine
Trazodone / Withdraw and wait at least one week / Withdraw and wait at least one week / Cross taper cautiously with very low dose of tricyclic / Withdraw then start citalopram at 10mg/day / Withdraw then start fluoxetine at 10mg/day / Withdraw then start paroxetine at 10mg/day
Moclobemide / Withdraw and wait 24 hours / Withdraw and wait 24 hours / Withdraw and wait 24 hours / Withdraw and wait 24 hours / Withdraw and wait 24 hours / Withdraw and wait 24 hours
Reboxetine / Withdraw and wait at least one week / Withdraw and wait at least one week / Cross taper cautiously / Cross taper cautiously / Cross taper cautiously / Cross taper cautiously
Venlafaxine / Withdraw and wait at least one week / Withdraw and wait at least one week / Cross taper cautiously with very low dose of tricyclic *2 / Cross taper cautiously. Start with 10mg/day / Cross taper cautiously. Start with 10mg/day / Cross taper cautiously. Start with 10mg/day
Mirtazapine / Withdraw and wait for two weeks / Withdraw and wait for two weeks / Withdraw then start tricyclic / Withdraw then start citalopram / Withdraw then start fluoxetine / Withdraw then start paroxetine
Duloxetine / Withdraw and wait for at least 5 days / Withdraw and wait for at least 5 days / Cross taper cautiously with very low dose of tricyclic *2 / Withdraw then start citalopram at 10mg per day / Withdraw then start fluoxetine / Withdraw then start paroxetine
Stopping*4 / Reduce over four weeks / Reduce over four weeks / Reduce over four weeks / Reduce over four weeks / At 20mg/day just stop. At higher doses reduce over two weeks / Reduce over four weeks or longer, if necessary*5
To
From / Sertraline / Trazodone / Moclobemide / Reboxetine / Venlafaxine / Mirtazapine / Duloxetine
Trazodone / Withdraw then start sertraline at 25mg/day / - / Withdraw and wait at least one week / Cross taper cautiously / Withdraw . Start venlafaxine at 37.5mg/day / Cross taper cautiously / Cross taper cautiously .Start duloxetine at 30mg per day.
Moclobemide / Withdraw and wait 24 hours / Withdraw and wait 24 hours / - / Withdraw and wait 24 hours / Withdraw and wait 24 hours / Withdraw and wait 24 hours / Withdraw and wait 24 hours
Reboxetine / Cross taper cautiously / Cross taper cautiously / Withdraw and wait at least one week / - / Cross taper cautiously / Cross taper cautiously / Cross taper cautiously
Venlafaxine / Cross taper cautiously. Start with 25mg/day / Cross taper cautiously / Withdraw and wait at least one week / Cross taper cautiously / - / Withdraw before starting mirtazapine cautiously / Withdraw. Start duloxetine 30mg/day. Increase very slowly.
Mirtazapine / Withdraw then start sertraline / Withdraw then start trazodone / Withdraw and wait one week / Cross taper cautiously / Cross taper cautiously / - / Withdraw. Start duloxetine 30mg/day. Increase very slowly.
Duloxetine / Withdraw then start sertraline at 25mg/day / Withdraw then start trazodone / Withdraw and wait one week / Cross taper cautiously / Withdraw, then start venlafaxine / Cross taper cautiously / -
Stopping*4 / Reduce over four weeks / Reduce over four weeks / Reduce over four weeks / Reduce over four weeks / Reduce over four weeks or longer, if necessary*5 / Reduce over four weeks / Reduce over four weeks

4.1 Hypnotics and anxiolytics

Hypnotics

  • Chloral Hydrate 500mg/5ml solution (unlicensed)
  • Clomethiazole/Chlormethiazole 192mg capsule
  • Chloral betaine(Cloral betaine) 707mg tablets
  • Nitrazepam 2.5mg/5ml suspension
  • Nitrazepam 5mg tablets
  • Temazepam 10mg, 20mg tablets
  • Temazepam 10mg/5ml oral solution
  • Zopiclone 3.75mg and 7.5mg tablets(Critical care and Mental Health Only)
  • Melatonin 2mg MR tablets

Dose

-Chloral hydrate oral solution 500mg/5ml: see BNF.

-Clomethiazole capsule 192mg; usually 1-2 capsules at bedtime

-Cloral betaine tablets 707mg: usually 1-2 tablets at bedtime.

-Nitrazepam tablets 5mg; oral solution 2.5mg/5mL: usually 5-10mg at bedtime

-Temazepamtablets 10mg, 20mg; oral solution 10mg/5mL: usually 10-20mg at bedtime.

-MelatoninMR tablets 2mg:2mg once a day at bedtime

Prescribing notes

  • Non-drug treatments are recommended as 1st line therapy
  • Routine prescribing for insomnia is undesirable and should be used in short courses only when insomnia is severe, disabling, or subjecting the individual to extreme distress.
  • New patients should not be put on a repeat prescription system and existing patients receiving an hypnotic should be reviewed and offered the chance to stop or reduce (see BNF withdrawal protocol).
  • There is no evidence that never hypnotics (zaleplon, zolpidem, zopiclone) provide any additional clinical benefit or a free from dependence.

Anxiolytics

  • Buspirone 5mg tablets(Mental health only)
  • Chlordiazepoxide 5mg and 10mg capsules
  • Diazepam 2mg, 5mg tablets
  • Diazepam 2mg/5ml syrup
  • Diazepam 5mg/ml injection
  • Lorazepam 1mg, 2.5mg tablets
  • Lorazepam 4mg/ml injection

Dose

-Buspironetablets 5mg: 5mg 2-3 times daily increased if necessary to max 45mg daily in divided doses.

-Chlordiazepoxidetablets 5mg, 10mg; capsules 10mg: For Anxiety: 10mg 3 times daily increased if necessary to 60-100mg daily in divided doses.

-Diazepamtablets 2mg, 5mg; oral solution 2mg/5mL: 2mg 3 times daily increased if necessary to 15-30mg daily in divided doses.

-Lorazepamtablets 1mg, 2.5mg; injection 4mg/ml: By mouth: 1-4mg daily in divided doses. Injection: see BNF.

Prescribing notes

  • Benzodiazepines are indicated for the short-term relief (2-4 weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress. The use of benzodiazepines benzodiazepines to treat short-term "mild" anxiety is inappropriate and unsuitable.
  • Treatment should be limited to the lowest dose possible for the shortest possible time.
  • Diazepam has a long duration of action and rapid onset. It is the recommended daytime anxiolytic and is used as premedication before surgery and other procedures.

Older Patients - Hypnotics and anxiolytics
  • Hypnotics and anxiolytics should be avoided in older patients if possible. Older patients can become ataxic, confused and are at increased risk of falling and injuring themselves.
MHRA Drug Safety Update
Addiction to benzodiazepines and codeine: supporting safer use
Article date: July 2011
Summary
Reminder for healthcare professionals:
  • Given the risks associated with the use of benzodiazepines, patients should be prescribed the lowest effective dose for the shortest time possible. Maximum duration of treatment should be 4 weeks, including the dose-tapering phase
  • Over-the-counter codeine-containing medicines should be used for the short-term (3 days) treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen, or aspirin alone (see Drug Safety Update September 2009)
Link:

4.2 Drugs used in psychoses and related disorders

Antipsychotic drugs

  • Chlorpromazine 25mg, 50mg and 100mg tablets
  • Chlorpromazine 25mg/5ml, 100mg/5ml syrup
  • Chlorpromazine 50mg/2ml injection
  • Flupentixol 500 micrograms, 1mg, 3mg tablets
  • Haloperidol 500 microgram capsule
  • Haloperidol 1.5mg, 5mg, 10mg tablets
  • Haloperidol 5mg/5ml oral liquid & 10mg/5ml oral liquid
  • Haloperidol 5mg/ml injection
  • Levomepromazine/Methotrimeprazine 25mg/ml injection -Palliative care only
  • Levomepromazine/Methotrimeprazine 25mg tablets – Palliative care only
  • Loxapine 25mg capsules(Unlicensed – Mental Health only)
  • Prochlorperazine 5mg tablets & 5mg/5ml syrup
  • Prochlorperazine 12.5mg/1ml injection
  • Sulpiride 200mg tablets
  • Sulpiride 200mg/5ml SF solution
  • Trifluoperazine 1mg, 5mg tablets
  • Trifluoperazine 1mg/5ml SF syrup
  • Trifluperazine 5mg/5ml SF solution
  • Zuclopenthioxol acetate 50mg/ml and 100mg/2ml injection

Dose

- Chlorpromazinetablets 10mg, 25mg, 50mg, 100mg; syrup 25mg/5mL, 100mg/5mL: initially 25mg 3 times daily (or 75mg at night) adjusted to response; usual maintenance dose 75-300mg daily (up to 1g daily may be required in psychoses).
- Chlorpromazineinjection 25mg/mL: by deep intramuscular injection (for acute symptoms), 25-50mg every 6-8 hours.

- Flupentixoltablets 500microgram, 1mg, 3mg: initially 3-0mg twice daily adjusted to response to max 18mg daily.
- Haloperidolcapsules 500micrograms; tablets 1.5mg, 5mg, 10mg, 20mg; oral liquid 1mg/mL, 2mg/mL: initially 500micrograms-3mg daily in 1-3 divided doses; in resistant schizophrenia up to 30mg daily may be needed; adjust according to response to lowest effective maintenance dose (5-10mg daily).
- Haloperidolinjection 5mg/mL, 10mg/mL: by intramuscular injection, 2-10mg 4-8 hourly according to response to total max 18mg daily; severely disturbed patients may need initial dose of up to 18mg.

- Levomepromazine: for palliative care use only.

- Prochlorperazinetablets 5mg:initially12.5mg twice daily, usual maintenance dose 75-100mg daily.
- Sulpiridetablets 200mg, 400mg: 0.4-2.4g daily in divided doses.

- Tifluperazine tablets 1mg, 5mg; oral solution 5mg/5ml; syrup 1mg/5ml:see BNF

- Zuclopenthioxol acetateinjection 50mg/ml and 100mg/2ml: see BNF

Atypical antipsychotics

  • Amisulpride 50mg, 200mg tablets & 500mg/5ml oral solution
  • Aripiprazole 5mg, 10mg, 15mg and 30mg tablets
  • Clozapine 25mg, 100mg tablets
  • Quetiapine 25mg, 100mg, 150mg, 200mg tablets
  • Quetiapine MR 50mg, 200mg, 300mg, 400mg tablets – mental health only
  • Olanzepine 2.5mg, 5mg, 7.5mg and 10mg tablets
  • Olanzepine 5mg and 10mg VELOTABS
  • Risperidone 0.5mg, 1mg, 2mg and 3mg tablets
  • Risperidone 5mg/5ml liquid

- Amisulpridetablets 50mg, 200mg, 400mg: acute psychotic episode, 400-800mg daily in divided doses, adjusted according to response; max 1.2g daily. Predominantly negative symptoms, 50-300mg daily. Doses up to 300mg may be given once daily.

- Aripiprazoletablets 5mg, 10mg, 15mg, 30mg:see BNF.
- Olanzapinetablets 2.5mg, 5mg, 7.5mg, 10mg:10mg daily adjusted to usual range of 5-20mg daily.
- Quetiapinetablets 25mg, 100mg, 150mg, 200mg, 300mg: (initiate with starter pack containing 6x25mg, 2x100mg and 2x150mg tablets) schizophrenia, 25mg twice daily on day 1, 50mg twice daily on day 2, 100mg twice daily on day 3, 150mg twice daily on day 4, then adjusted to response; usual range 300-450mg daily in 2 divided doses; max 750mg daily.
- Risperidonetablets 500micrograms, 1mg, 2mg, 3mg, 4mg, 6mg; liquid 1mg/mL: 2mg in 1-2 divided doses on day 1 then 4mg in 1-2 divided doses on day 2 (slower titration appropriate in some patients); usual dose 4-6mg daily. Doses above 10mg/day generally have not been shown to provide additional efficacy to lower doses and may increase risk of side-effects (max 16mg/day).
- Clozapinetablets 25mg, 100mg.

Antipsychotic depot injections

  • Flupentixol deconate 20mg/ml, 40mg/2ml, 50mg/0.5ml, 100mg/ml injection
  • Fluphenazine deconate 25mg/ml, 100mg/ml injection
  • Haloperidol deconate 50mg/ml, 100mg/ml injection
  • Risperidone consta 25mg, 37.5mg, 50mg injection
  • Zuclopenthixol deconate 200mg/ml, 500mg/ml injection

Dose

- Flupentixol decanoateoily injection 20mg/mL, 100mg/mL, 200mg/mL: test dose 20mg then after at least 7 days 20-40mg every 2-4 weeks, adjusted to response; max 400mg weekly; usual maintenance dose 50mg every 4 weeks to 300mg every 2 weeks.
- Fluphenazine decanoateoily injection 25mg/mL, 100mg/mL: test dose 12.5mg (6.25mg in elderly), then, after 4-7 days, 12.5-100mg every 14-35 days, adjusted according to response.
- Haloperidol decanoateoily injection 50mg/mL, 100mg/mL: initially 50mg every 4 weeks, if necessary increasing by 50mg increments to 300mg every 4 weeks; higher doses may be needed. Note: if 2-weekly administration preferred, doses should be halved.
- Zuclopenthixol decanoateoily injection 200mg/mL, 500mg/mL: test dose 100mg, followed after at least 7 days by 200-500mg or more, repeated at intervals of 1-4 weeks, adjusted according to response; max 600mg weekly.
- Risperidonelong-acting injection 25mg, 37.5mg, 50mg (Risperdal Consta®): refer to product information.

Prescribing notes

  • Indications for antipsychotics include schizophrenia and other psychoses, mania and short-term adjunctive management of psychomotor agitation.
  • Antipsychotics should be initiated with caution in the first episode (i.e. start with low dose), and monitored carefully due to the risk of adverse effects.
  • Haloperidol is a high potency antipsychotic with a high incidence of extrapyramidal side-effects; sulpiride is useful for those who cannot tolerate haloperidol.
  • Amisulpride may increase prolactin and cause agitation and anxiety. However, it is less likely to cause hypotension, sedation, weight gain, and anticholinergic and extrapyramidal side-effects.
  • Olanzapine can cause weight gain and sedation.
  • Quetiapine can be sedative and can cause weight gain but is less likely to cause hyperprolactinaemia.
  • Risperidone is associated with a dose dependent increase in extrapyramidal side-effects, especially at doses of 6mg daily and above.
  • Risperidone orodispersible and Olanzapine orodispersible tablets should be reserved for the treatment of acute episodes of schizophrenia in patients who are uncooperative or wary of taking oral medication. They are not intended for long-term use.
  • Clozapine should be initiated and maintained by specialists. Patients must be registered with the Clozaril Patient Monitoring Service. Clozapine can cause serious side-effects such as agranulocytosis, seizures, cardiomyopathy and myocarditis. Gastro-intestinal obstruction and paralytic ileus may also occur.
  • Hyperglycaemia has been reported in patients treated with atypical antipsychotics. Patients with diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus who start atypical antipsychotics should undergo fasting blood glucose testing at the beginning of, and during, treatment. Any patient receiving atypical antipsychotics should be monitored for symptoms of hyperglycaemia e.g. polydipsia, polyuria, polyphagia, weakness. Patients who develop symptoms of hyperglycaemia during treatment should undergo fasting blood glucose testing. Hyperglycaemia may resolve when the atypical antipsychotic is discontinued but some patients require continuation of anti-diabetic treatment.
  • Patients should remain on the antipsychotic which controlled their symptoms unless symptoms return or side-effects are intolerable; the dose should be monitored and reviewed regularly with specialist advice.
  • Specialist advice should be sought before discontinuing antipsychotics due to the risk of relapse.
  • Depot injections should be initiated on specialist advice, for the patient's convenience or to improve compliance. They may produce more extrapyramidal reactions than oral preparations.
  • The BNF recommends that a test dose of the depot injection should be given first since some side-effects are prolonged.
  • Individual responses to antipsychotic depot injections are variable; treatment should be selected and titrated according to the patient's response. There is no evidence that any one depot antipsychotic is particularly suitable for a specific patient group.
  • Risperidone is the first atypical antipsychotic to be available as a long-acting injection. The injection should only be prescribed by specialists and not by primary care. It should be considered if the following apply: the patient has experienced unacceptable side-effects with conventional antipsychotics; the patient has responded favourably to oral risperidone but prefers a long-acting IM injection; the patient has responded favourably to an oral atypical but there are concerns about long-term compliance.

Older Patients - Antipsychotics
Antipsychotics are frequently prescribed in the management of behavioural disorders associated with dementia. Other forms of management should also be considered before prescribing antipsychotics. It is important to remember that such behaviour can be a temporary phenomenon and that drugs should be prescribed on a short-term basis. In the elderly, antipsychotics should be used with caution because of the side-effect profile, including extrapyramidal symptoms, sedation, anticholinergic effects, cardiovascular effects and tardive dyskinesia.
MHRA Drug Safety Update
Antipsychotics: initiative to reduce prescribing to older people with dementia
Article date: May 2012
Summary
There have been increasing concerns over recent years about the use of antipsychotics to treat the behavioural and psychological symptoms of dementia (BPSD). Antipsychotics are associated with an increased risk of cerebrovascular adverse events and greater mortality when used in this population (see Drug Safety Update, March 2009). No antipsychotic (with the exception of risperidone in some circumstances) is licensed in the UK for the treatment of BPSD; however, antipsychotics are often prescribed off-label for this purpose.
Link:

Antimanic drugs