Quality Statement 6: Switching Psychotropic Medications

Resources Quality Statements Advisory Committee About

6

Switching Psychotropic Medications

People living with dementia who are prescribed psychotropic medications to help reduce agitation or aggression have their medication discontinued and an alternative psychotropic medication prescribed if symptoms do not improve after a maximum of 8 weeks. Ineffective medications are discontinued to avoid polypharmacy. The reasons for the changes in medication and the consideration of alternative psychotropic medications are documented.

Background

Psychotropic medications should be switched after a maximum of 8 weeks for people living with dementia and symptoms of agitation or aggression if there has been no clinical improvement in the target behavioural symptoms. An alternative type or class of medication may be considered for trial instead. The medications should not be combined in an attempt to improve effectiveness, except in very special circumstances such as augmentation for a partial drug response. Multiple medications can lead to issues of polypharmacy and the increased likelihood of drug-drug interactions and adverse events.

What This Quality Statement Means

For Patients

Your team of health care professionals should help you find the right medication to fit your needs.

For Clinicians

When people living with dementia are taking psychotropic medications to treat agitation or aggression, switch them to an alternative psychotropic medication if their symptoms do not improve after a maximum of 8 weeks. Discontinue ineffective medications before switching to avoid polypharmacy. Document your reasons for the change in medication and considerations of alternative psychotropic medications.

For Health Services

Ensure there are systems, processes, and resources in place in hospitals and long-term care homes for switching psychotropic medications in people who do not respond after 8 weeks, and for documenting the reasons for the change in medications as well as consideration of alternative medications.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression receiving psychotropic medications who have their psychotropic medication discontinued and are switched to an alternative psychotropic medication if symptoms have not improved after 8 weeks

Denominator: total number of people living with dementia and symptoms of agitation or aggression who continuously receive a psychotropic medication and whose symptoms do not improve after 8 weeks
Numerator: number of people in the denominator who have their psychotropic medication discontinued and are switched to an alternative psychotropic medication
Data source: local data collection

Definitions Used Within This Quality Statement

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