Antipsychotic medicines for people living with dementia should only be offered to those who are either at risk of harming themselves or others, or experiencing agitation, hallucinations or delusions that are causing them severe distress. Before antipsychotics are started, the benefits and risks of taking the medicine should be discussed with the person and their family members or carers. Antipsychotics can cause serious side effects such as increased risk of stroke and death. 

To support this discussion, NICE has developed a decision aid that may be beneficial when consulting with a person with dementia on the pros and cons of starting an antipsychotic medicine.

Antipsychotics should be prescribed at the lowest effective dose and used for the shortest time possible. The person should be reassessed at least every six weeks to see if the medicine is still needed. Antipsychotics should be stopped on the advice of a specialist if the person is not getting a clear benefit and after a discussion with the person taking them and their family members or carers. 

Access to psychosocial and environmental interventions for distress should continue while the person is prescribed antipsychotics and after they have stopped taking them. Only risperidone (for up to six weeks use) and haloperidol have a licence to treat these sorts of symptoms in people living with dementia. Other antipsychotics may still help, and a healthcare professional can prescribe them, but using them or using risperidone for longer than six weeks, would be seen as an off-label use.

For more information and advice on how to manage other non-cognitive symptoms of dementia, such as depression and anxiety, sleep problems and Parkinson symptoms, see the NICE guideline NG97 Recommendations for managing non-cognitive symptoms.

Practice point

Familiarise yourself with the NICE decision aid Antipsychotic medicines for treating agitation, aggression and distress in people living with dementia discussed above.

• What would you discuss with a patient to enable them to make an informed decision about taking an antipsychotic medicine? 

Once you've completed this module, move onto:
Part five: Advance care planning
But be sure to click next to complete this module first.