Antipsychotics Drugs

Antipsychotic drugs are medicines originally developed to treat conditions such as schizophrenia and bipolar disorder. They are also sometimes prescribed to people with dementia who experience agitation, aggression, hallucinations or delusions. If a doctor suggests one for your loved one, it helps to understand the benefits, the risks and the alternatives.

Why they’re prescribed in dementia

As dementia progresses, many people develop changes in behavior and mood, such as restlessness, suspicion, distress or seeing things that aren’t there. When these symptoms put the person or others at risk, or cause severe distress, doctors may consider medication.

Important safety warnings

• FDA boxed warning. The FDA requires its strongest warning on antipsychotic drugs, stating that older adults with dementia-related psychosis who take them have a higher risk of death than those who don’t.
• Other risks include stroke, falls, excessive sleepiness, confusion, stiffness or tremors, weight gain and pneumonia.
• Lewy body dementia and Parkinson’s. People with Lewy body dementia, including Parkinson’s disease dementia, can have severe and sometimes dangerous reactions to some antipsychotics. Always make sure every doctor knows about this diagnosis.

FDA-approved options

Most antipsychotics used in dementia are prescribed “off-label.” A few have specific approvals:

• Rexulti (brexpiprazole) was approved by the FDA in 2023 for agitation associated with dementia due to Alzheimer’s disease, and it still carries the boxed warning.
• Nuplazid (pimavanserin) is approved for hallucinations and delusions associated with Parkinson’s disease psychosis.

Try non-drug approaches first

Experts generally recommend non-drug approaches as the first step for most behavior changes in dementia. Behaviors are often a way of communicating an unmet need. Look for causes such as:

• Pain, constipation, hunger, thirst or needing the bathroom
• Infections, such as a urinary tract infection
• Side effects or interactions from other medicines
• Poor sleep
• Too much noise, crowding or a change in routine
• Boredom, loneliness or fear

Helpful approaches include a calm, predictable routine, meaningful activities, music, gentle reassurance, redirection, and adjusting the environment. Caregivers trained in dementia care often use these techniques every day.

If medication is needed

Sometimes an antipsychotic is the right choice, for example when symptoms are severe, dangerous or very distressing and other approaches haven’t helped. In that case, doctors generally aim to use the lowest effective dose for the shortest time and review regularly whether it’s still needed.

Questions to ask the doctor

• What symptom is this medicine meant to treat?
• What are the risks for my loved one specifically?
• Have we ruled out pain, infection and other medicines as causes?
• How will we know if it’s working?
• When will we review the dose or try reducing it?
• Is this safe with Lewy body dementia or Parkinson’s?

Working together

Families, doctors and caregivers working as a team can usually find the safest approach. In memory care, caregivers watch for changes, use non-drug approaches, and share observations with the resident’s doctor and pharmacist.

This article is for general information and is not medical advice. Never start, stop or change a medicine without talking with the prescribing doctor.

Have questions about memory care for someone you love? Call Generations Senior Living at (352) 474-2696 or schedule a tour of one of our three homes near The Villages.