Deprescribing Antipsychotics for Behavioral and Psychological Symptoms of Dementia and Insomnia
Am Fam Physician. 2018 Sep 15;98(6):394-395.
See related article from FPM: Deprescribing Unnecessary Medications A Four-Part Process
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• In collaboration with the patient and caregivers, antipsychotics should be deprescribed for behavioral and psychological symptoms of dementia after at least three months of a good therapeutic response or no response to treatment.
• If deprescribing fails, reinitiation of treatment using the lowest dosage possible can be considered with another attempt to deprescribe in three months.
• Antipsychotics prescribed for primary or secondary insomnia, in which comorbidities are under control, should be discontinued without tapering.
From the AFP Editors
Antipsychotics have been shown to be effective for treating behavioral and psychological symptoms of dementia in older persons and are commonly used to treat insomnia; however, these medications are often continued in the long term without appropriate supervision and reassessment of their benefit. Because these medications are linked to significant adverse effects, including a greater risk of death and increased cerebrovascular events, deprescribing (i.e., discontinuing or reducing the dosage of a potentially harmful or nonbeneficial medication with careful planning and monitoring) is recommended in appropriate patients. As part of the Deprescribing Guidelines in the Elderly Project (http://www.open-pharmacy-research.ca/research-projects/emerging-services/deprescribing-guidelines), a Canadian team consisting of two family physicians, one geriatric psychiatrist, two geriatricians, and four pharmacists has provided recommendations to guide physicians in deprescribing antipsychotics for behavioral and psychological symptoms of dementia and insomnia. The team concluded that the benefits of deprescribing outweigh the harms in this population.
The first step is to assess the indication for anti-psychotic therapy and clarify if it is a psychiatric condition with psychosis vs. behavioral symptoms of dementia. In collaboration with the patient and his or her caregivers, ant
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This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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