Follow-up and duration of antipsychotic therapy for agitation, aggression or psychosis of dementia
When an antipsychotic is used to treat a behavioural and psychological symptom of dementia, effectiveness will be evident within 2 weeks of starting therapy; during this time, review the target behaviour weekly and stop the antipsychotic if no benefit is seen1. Also stop the antipsychotic if a problematic adverse effect occurs.
If the patient tolerates the antipsychotic and is experiencing an improvement in the target symptom, continue therapy and review response every 4 to 6 weeks. Also monitor for antipsychotic adverse effects according to the schedule set out here. If the patient is not receiving an obvious ongoing benefit or a problematic adverse effect occurs, stop the antipsychotic.
Avoid continuing an antipsychotic for longer than 12 weeks to treat agitation, aggression or psychosis of dementia because behavioural and psychological symptoms are often temporary.
If the antipsychotic is stopped within 12 weeks and the patient’s symptoms were not initially severe, the antipsychotic can be stopped abruptly. However, if the antipsychotic has been continued for 12 weeks or longer, or symptoms were initially severe, consider slowly reducing the antipsychotic dose to reduce the risk of withdrawal effects—a similar approach to that described in Deprescribing a long-term antipsychotic for behavioural and psychological symptoms of dementia may be used.