Antipsychotic drugsWhat are antipsychotic drugs?Antipsychotic drugs are used to treat people who are experiencing severe agitation, aggression or distress from psychotic symptoms, such as hallucinations and delusions. They tend to be used only as a last resort, such as when the person, or those around them, are at immediate risk of harm. Show
For some people, antipsychotics can help to reduce the frequency or intensity of these changes. However, they also have serious risks and side effects, which the doctor must consider when deciding whether to prescribe them. The first prescription of an antipsychotic should only be done by a specialist doctor. This is usually an old-age psychiatrist, geriatrician or GP with a special interest in dementia. What antipsychotic drugs may be prescribed for a person with dementia?There are several antipsychotic drugs that may be used. Each one has slightly different effects on the brain and has its own potential risks and side effects. The drug with the most evidence to support its use in dementia is risperidone. It is licensed for short-term (up to six weeks) treatment of persistent aggression in people with moderate-to-severe Alzheimer’s disease when there is risk of harm to the person or others. However, this is only if non-drug approaches have already been tried without success. An older antipsychotic called haloperidol is licensed for use in people with Alzheimer’s disease or vascular dementia. However, most doctors consider its risks and side effects in people with dementia to be too severe. It tends to be used only in emergencies as a last resort. What are off-label antipsychotics drugs?Other antipsychotic drugs prescribed for people with dementia are done so ‘off-label’. This means that the doctor can prescribe them if they have good reason to do so, and provided they follow guidance set out by the General Medical Council. A doctor may choose to prescribe an off-label antipsychotic drug when it offers a better balance of benefits and risks for an individual patient. For example, risperidone may be effective in people with dementia, but it also increases the risk of having a stroke. So if a person has already had a stroke it might be safer to prescribe an off-label drug that doesn’t carry this risk, even though it might be less effective. The off-label antipsychotics most often used for patients with dementia are:
How are antipsychotic drugs reviewed?Antipsychotic drug treatments should be reviewed after six or 12 weeks, or both. When the prescription of an antipsychotic is reviewed, the doctor may suggest stopping the drug in one go (for people taking a low dose of antipsychotic) or a more gradual reduction (for people on a higher dose) known as ‘tapering’. In either case, the effects on the person’s behavioural and psychological changes should be closely monitored. If they seem to be getting worse, it may be necessary to restart or increase the dose again. If the person had a pre-existing mental health condition before they developed dementia and this was managed with antipsychotic drugs, they should continue to take them as prescribed by their psychiatrist. Who can antipsychotic drugs help?Some antipsychotics can have a small but significant beneficial effect on agitation, aggression and, to a lesser extent, psychosis in people with Alzheimer’s disease. Improvements are normally only seen once these drugs have been taken for several weeks. Antipsychotic drugs may be prescribed for people with Alzheimer’s disease, vascular dementia or mixed dementia (which is usually a combination of these two). If a person with dementia with Lewy bodies or Parkinson’s disease dementia is prescribed an antipsychotic drug, it should be done with the utmost care, under constant supervision and with regular review. This is because people with these types of dementia, who often have visual hallucinations, are at particular risk of severe negative reactions to most antipsychotics. The doctor is likely to choose a drug with the least side effects, but they will only be able to use very small doses. This is unlikely to have much effect on agitation and psychosis. Issues with the use of antipsychotic drugsAntipsychotic drugs can cause serious side effects, and the risk increases with continued use over weeks and months. Possible negative effects of antipsychotics include:
The decision to use antipsychotics should be taken very seriously. Benefits may sometimes come at the expense of the person’s health and quality of life. When considering prescribing an antipsychotic, the doctor will check if the person has high blood pressure, an irregular heartbeat, diabetes or a history of strokes. This is because these conditions carry additional risks for a person taking antipsychotic drugs. There is evidence that some people with dementia who may not need antipsychotics are still being prescribed them. For example, they are being prescribed to treat distress or aggression before non-drug approaches have been tried thoroughly. Also, some people are kept on an antipsychotic for too long without a review at 12 weeks or a clear plan for when they should come off the drug. There is an ongoing national drive to reduce inappropriate prescribing of antipsychotic drugs in dementia, especially for people in the later stages of dementia living in residential care. Alzheimer’s Society would like to see these drugs used only when they are really needed. Questions to ask the doctor about antipsychotic drugsIf the person with dementia can consent to taking an antipsychotic drug, they need to be properly informed about the drug. If a doctor is making the decision, the person with dementia and their carer should still be involved as much as possible and should be shown their care plan. The following questions may help with discussions:
Useful organisationsGeneral Medical Council (GMC)Telephone Email Website The GMC helps protect patients and improve UK medical education and practice by supporting students, doctors, educators and healthcare providers. It provides guidance on the prescribing of medication, including off-label drugs. Medicines and Healthcare products Regulatory Agency (MHRA)Telephone Email Website The MHRA products website provides detailed information on specific drugs, and the ‘Yellow Card’ scheme for reporting side effects. Review detailsLast reviewed: July 2021 Reviewed by: Dr Sharmi Bhattacharyya, Consultant & Clinical Lead, Older People’s Mental Health, North Wales Betsi Cadwaladr University Health Board and Dr Manoj Rajagopal, Consultant Old Age Psychiatrist and Associate Medical Director, Lancashire & South Cumbria NHS Foundation Trust This information has also been reviewed by people affected by dementia. Can medication be an effective way to treat the symptoms of dementia?Most of the medicines available are used to treat Alzheimer's disease as this is the most common form of dementia. They can help to temporarily reduce symptoms.
What is the best way to manage behaviors associated with dementia?Person-centred care and communication, sensory stimulation and listening to music are three evidence-based therapies that can help reduce agitation and other challenging behaviours for people with dementia.
What is the most effective treatment for dementia?Cholinesterase inhibitors.
These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.
What medication is used to treat behaviors?The types of medications that might be used include antidepressants (if the patient has depression); anti-anxiety drugs (also called anxiolytics), anti-psychotic medications (some of which are also called neuroleptics); sedatives, and sleep medications.
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Medications are the most effective way of treating behavioural symptoms of dementia.
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