AN antipsychotic drug, which is not recommended for dementia treatment, is being prescribed to dementia sufferers in Northern Ireland.
The drug, Olanzapine, is prescribed to over 65s by every health trust in Northern Ireland. It is used in the treatment of schizophrenia and bipolar disorder.
In addition to this, the Western Trust and the Belfast Trust both admitted to The Detail that Olanzapine is prescribed to dementia patients within their trusts’ care.
The Southern Trust, South Eastern Trust and Northern Trust neither confirmed nor denied this, but all accepted that their trusts prescribed this drug to over 65s.
When contacted, a spokesperson for the UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA) referred to evidence from the European Medicines Agency (EMA), an EU body, which states: “Olanzapine is not recommended for use in patients with dementia-related psychosis and/or behavioural disturbances because of an increase in mortality and the risk of cerebrovascular accident.”
The MHRA spokesperson added that the prescribing of Olanzapine should comply with licensing terms.
In the United States, the Food and Drugs Administration (FDA) says that Zyprexa, a brand name of Olanzapine, is “not approved for the treatment of patients with dementia-related psychosis”, citing increased rates of mortality.
The Detail contacted the Department of Health (DoH), explaining both the MHRA's and FDA's positions.
We asked the department if it was aware how widespread the use of Olanzapine is in the treatment of dementia patients aged over 65 in Northern Ireland, but this question was not directly answered.
Additionally, despite being asked, the DoH did not express concern at Olanzapine being used to treat dementia.
The department cited the National Institute for Health and Care Excellence (NICE) guidelines on dementia treatment being adopted in Northern Ireland.
The DoH spokesperson said: “The guidance outlines that healthcare providers should offer psychosocial and environmental interventions to reduce distress in people living with dementia as initial and ongoing management.
“Within this context, Olanzapine is sometimes used as part of the treatment of people aged 65 years and over, primarily as treatment for schizophrenia and bipolar disorder.
“Treatment decisions, as to whether to prescribe particular medicines, are a matter for individual clinicians to make, guided by the available evidence and best practice guidance, in conjunction with patients and their carers, and following a careful assessment of the balance of risks and benefits for individual treatments."
The Detail also asked for the DoH to confirm whether or not the use of Olanzapine, in the treatment of elderly patients in Northern Ireland, formed part of any drug trials or research. This question was ignored.
We contacted the Royal College of Psychiatrists in Northern Ireland (RCPsych NI) about issues relating to the prescription of Olanzapine for elderly people.
A spokesperson asked us: "What is the case you’re referring to in your story? Who is questioning the prescribing? Who prescribed the drug – was it a psychiatrist or another type of doctor? What condition did the person, who was prescribed it, have?"
We declined to provide the RCPsych NI with this information. On this basis, the RCPsych NI refused to comment.
The chair of the RCPsych NI is Dr Richard Wilson. He was elected in December 2019 but only took on the post last month. Professor Gerry Lynch was previously the chair.
Previously, The Detail reported on Northern Ireland having weaker legal protections than the rest of the UK with regards to age discrimination legislation.
Eddie Lynch, Northern Ireland’s Commissioner for Older People, called this a “gap in protection”.
This legislative gap applies to older people in Northern Ireland when they engage with all public services, including health and social care services.
We also previously reported on how, despite political pressure, First Minister Arlene Foster and deputy First Minister Michelle O'Neill could not provide any timeframe for when they aim to implement new age discrimination legislation to address this issue.