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Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj-2023-076268 (Published 17 April 2024) Cite this as: BMJ 2024;385:e076268

Linked Editorial

Use of antipsychotics in adults with dementia

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Re: Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study

Dear Editor,

Mok and colleagues  found increased risk for a broad range of adverse outcomes in adults with dementia treated with antpsychotics. In particular, risks were described to be highest in the first seven days of treatment. The mean age of the study population at diagnosis of dementia is 82.1 years (SD 7.9 years). Elderly people are notoriously vulnerable to adverse drug effects for age related changes of pharmacokinetics and pharmacodynamics, frailty, multimorbidity and polypharmacy. According to geriatric practice, titration at the beginning of a pharmacological therapy is often used to minimize adverse effects.

In light of these data, in the first week of antipsychotic treatment, the drug should be started in elderly people at a very low dose, even subtherapeutic, and titrated up very slowly.

Competing interests: No competing interests

21 April 2024
Arianna de Lalla
MD,PHD, Hospitalist
University Hospital of Siena, Tuscany, italy
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