Experts have found that dementia patients risk increased chance for stroke with risperidone, a commonly prescribed drug for patients. A study involving more than 165,000 people with dementia in the United Kingdom found that the risperidone increases the risk of stroke in all patients studied, undermining the idea that there is any group for whom the drug is clearly safe. Risperidone is a strong antipsychotic that is often prescribed to people with dementia who experience severe agitation, particularly in care home settings when non-drug approaches have not worked.
The researchers found that stroke risk increased even among patients with no prior history of heart disease or stroke. This challenges existing assumptions about which patients might safely use the drug and raises concerns about how risperidone, the only licensed medication of its kind for dementia, is prescribed and monitored.
The results, published in the British Journal of Psychiatry, are however expected to spark debate about current clinical practice, report said. According to Dr. Byron Creese of Brunel University of London, one of the most notable findings was the uniformity of risk across different patient groups. “We knew Risperidone causes stroke, but we didn’t know whether some groups of people might be more at risk than others. We thought if we might identify characteristics that make people more at risk, doctors could avoid prescribing to patients with those characteristics,” Dr. Creese said.
According to medical data, about half of people living with dementia experience agitation, which could cause intense distress for both patients and caregivers. When non-drug treatments fail, risperidone is sometimes used as a last option. The new findings intensify the difficult decisions faced by clinicians and families, who must balance the drug’s potential to reduce extreme agitation against its clearly elevated risk of stroke. The drug, used to calm aggression, carries known risks of stroke in elderly patients.
Yet there is still no dementia-specific guidance on how doctors should monitor those dangers. NHS guidelines limit risperidone use to six weeks for severe symptoms, but many patients take it longer, with monitoring standards varying across the country. According to Creese, there are no UK-licensed alternatives for risperidone in such cases; so it is about making sure the risks are clearly explained and carefully weighed.
People with a history of stroke already face a high risk of another stroke. If a stroke happens after taking risperidone, it may not be just because of the drug. Doctors only use risperidone as a last resort.
