What are antipsychotics in dementia?

It is a boxed warning the FDA requires on these drugs, telling doctors and families that older adults with dementia who take antipsychotic medications may have an increased risk of death. MedlinePlus, describing quetiapine, adds an increased risk of stroke or ministroke and notes the drug is not approved for behavior problems in older adults with dementia. If someone with dementia takes an antipsychotic, talk with the prescribing doctor.

Research has linked antipsychotics to a higher risk of stroke and death in older adults with dementia, the Alzheimer's Association says. For that reason it advises using them only when symptoms come from mania or psychosis, when symptoms endanger the person or others, or when the person has persistent distress or great difficulty receiving care. They should never be used to sedate or restrain someone, and the doctor should monitor side effects.

Sometimes, after other approaches fail. The Alzheimer's Association says brexpiprazole (Rexulti) is the only atypical antipsychotic approved by the FDA for agitation in Alzheimer's dementia, though many antipsychotics are used off label. The National Institute on Aging says experts agree drugs for behavior should be used only after non-drug strategies have been tried. Brexpiprazole's possible side effects include dizziness, high blood sugar and stroke.

They need extreme caution. The Alzheimer's Association says antipsychotics may cause serious side effects in as many as 50 percent of people with Lewy body dementia, including sudden changes in consciousness, impaired swallowing, acute confusion and worse Parkinson's symptoms. The National Institute on Aging says that if one is prescribed, it should be a newer atypical antipsychotic at the lowest dose for the shortest time.

Beyond the higher risk of stroke and death, MedlinePlus lists common side effects of quetiapine, one antipsychotic, as dizziness and trouble with balance, dry mouth, nausea, constipation, weight gain and loss of coordination. Falls, seizures and uncontrollable movements of the face or limbs are serious and need a doctor right away. People with Lewy body dementia can react more severely. Report any change to the prescriber.