Quality Statement 5: Titrating and Monitoring Psychotropic Medications

Resources Quality Statements Advisory Committee About

5

Titrating and Monitoring Psychotropic Medications

People living with dementia who are prescribed psychotropic medications to help reduce agitation or aggression are started on low dosages, with the dosage increased gradually to reach the minimum effective dosage for each patient, within an appropriate range. Target symptoms for the use of the psychotropic medication are monitored and documented.

Background

People living with dementia are usually elderly, often with comorbid conditions, and may be at increased risk for adverse effects from pharmacological agents. To reduce the risk of adverse events, initial low dosages of medications are suggested, with slow titration to reach the optimal tolerated therapeutic dosage. Frequency of monitoring is dependent on individual factors including symptoms, the onset of action, and risks associated with the medications provided.

What This Quality Statement Means

For Patients

If they are used, medications should be started at a low dosage and gradually increased until your symptoms improve.

For Clinicians

When prescribing psychotropic medication, start with a low dosage and gradually increase it to reach the minimum effective dosage for the person, within an appropriate range. Regularly monitor and document the person’s target symptoms.

For Health Services

Ensure there are systems, processes, and resources in place in hospitals and longterm care homes for appropriately introducing and adjusting the use of psychotropic medications and monitoring people’s target symptoms.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression receiving psychotropic medications who have their target symptoms monitored and documented

Denominator: total number of people living with dementia and symptoms of agitation or aggression who are prescribed a psychotropic medication
Numerator: number of people in the denominator whose target symptoms are monitored and documented
Data source: local data collection

Definitions Used Within This Quality Statement

Psychotropic medications

These categories of psychotropic medications are typically used for reducing symptoms of agitation and aggression in people living with dementia:

Antipsychotics
Antidepressants
Mood stabilizers
Benzodiazepines
Other hypnotics

Evidence to Improve Care