Rationalising antipsychotics in palliative care

Follow the principles of rationalising psychotropics when rationalising antipsychotics in palliative care.

For patients taking antipsychotics for behavioural and psychological symptoms of dementia, follow the approach to deprescribing antipsychotics in the Psychotropic guidelines. If the antipsychotic cannot be stopped, plan to switch to an alternative that can be administered subcutaneously (eg haloperidol) in the last days of life.

Expert advice from the patient’s psychiatrist or mental health team is required when rationalising antipsychotics used for psychotic or bipolar disorders to prevent relapse and distressing withdrawal effects. Antipsychotics are often continued at the patient’s usual doses, and may require tapering during the last months of life to avoid acute withdrawal effects (eg agitation, cholinergic rebound syndrome) in the last days of life. Alternatively, switching to a long-acting injectable antipsychotic may be considered. Close monitoring for recurrence of symptoms is required when changing drug therapy. See also Stopping an antipsychotic in the Psychotropic guidelines.