Antipsychotics in dementia: Best Practice Guide
Other medicines for BPSD
Cholinesterase inhibitors
Cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine) may be considered for the treatment of psychotic symptoms, agitation or aggression if a non-pharmacological approach is inappropriate or has been ineffective, and antipsychotics are inappropriate or have been ineffective.13
Benzodiazepines (e.g. diazepam, lorazepam) and zopiclone
Generally these should be avoided as they can increase confusion, impair cognition and gait and cause sedation. The risk of a fall may be increased especially if combined with other medicines that cause sedation or postural hypotension. Benzodiazepines cause disinhibition and have the potential to worsen behavioural disturbances. If a benzodiazepine is considered necessary for severe agitation this should be reviewed and preferably stopped after a maximum of two weeks.4 Zopiclone may also be useful but carries the same prescribing precautions as the benzodiazepines. A meta-analysis of sedative use in older people with insomnia showed that the experience of an adverse effect was about twice as likely as an improvement in sleep quality.19
Anticonvulsants
Sodium valproate and carbamazepine have been used for agitated behaviour associated with dementia but the supporting evidence is very weak. Both have a significant potential for serious adverse effects and drug interactions and are not generally recommended.
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