Kevin T. Bain, Emily J. Schwartz, Rengena Chan-Ting. Reducing Off-Label Antipsychotic Use in Older Community-Dwelling Adults With Dementia: A Narrative Review. J Am Osteopath Assoc 2017;117(7):441–450. doi: 10.7556/jaoa.2017.090.
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The off-label use of antipsychotics for the management of behavioral and psychologic symptoms of dementia (BPSD) in older adults (age ≥65 years) is common, despite evidence of modest benefits and serious risks. Although national initiatives aimed at reducing antipsychotic use among older adults with BPSD in nursing homes have been successful, similar initiatives are lacking for community-dwelling adults with dementia. As a result, older adults with BPSD residing in the community may be at an even greater risk of being negatively affected by antipsychotic use. Physicians should be knowledgeable of this issue and understand the alternatives to antipsychotics, as well as how to reduce antipsychotic use in patients with dementia who are already taking antipsychotics.
a Trazodone is an antidepressant in the serotonin antagonist and reuptake inhibitor class.
b Dextromethorphan is a sigma-1 receptor agonist and quinidine is an antiarrhythmic agent.
Abbreviations: ADE, adverse drug event; SSRI, selective serotonin reuptake inhibitor.
a Doses extracted or verified from Lexicomp (Wolters Kluwer). None of these antipsychotics is approved by the US Food and Drug Administration for the management of behavioral and psychological symptoms of dementia.
b Wide intrapatient variability exists in doses used for the off-label management of behavioral and psychological symptoms of dementia.
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