Antipsychotics can be safely withdrawn: Cochrane review

Most elderly dementia patients can be safely taken off antipsychotic drugs without behavioural relapses, a new Cochrane review concludes.

But caution should be applied when patients have more severe neuropsychiatric symptoms or have responded well to the drugs. Eight out of nine randomised trials included in the review found patients who stopped taking the drugs had the same behavioural outcomes as those who continued.

The ninth trial found people with psychosis or agitation who had responded well to risperidone therapy for four to eight months were more likely to relapse within the following four months.

Mieke Van Driel, a Professor of General Practice at the University of Queensland who contributed to the review, said too many patients were left on the drugs indefinitely.

“It has become a routine thing to do when someone is a bit difficult,” she said.

“Once patients are put on antipsychotic drugs they usually stay on them and nobody stops them. There are people who might need it in an acute phase but we could wean them off once they have stabilised,” she said.

Antipsychotic drugs have been shown to increase mortality and have been related to other health problems in the elderly such as falls, she added, heightening the need to discontinue them where possible. Patients who respond well to the drugs may benefit from longer term treatment, but this was based on a single study and remained largely speculative, she said.

The review, which included 606 patients, looked at trials involving a range of antipsychotics prescribed at various doses.Both abrupt and gradual withdrawal schedules were involved, but the review did not determine which method was best.

Prof Van Driel said it was best left to individual clinician judgement, but recommended weaning in cases where there was limited face-to-face time with patients.

The Cochrane Library 2013; online abstract for antipsychotic recommendations as per above - http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007726.pub2/abstract