Withdrawal of Antidementia Drugs in Older People: Who, When and How?

The evidence base to guide withdrawal of antidementia medications in older people with dementia is limited; while some randomised controlled studies have considered discontinuation of cholinesterase inhibitors (ChEIs), no such studies examining discontinuation of the N-methyl-D-aspartate receptor antagonist memantine have been conducted to date. The purpose of this opinion article was to summarise the existing evidence on withdrawal of cholinesterase inhibitors and memantine, to highlight the key considerations for clinicians when making these prescribing decisions and to offer guidance as to when and how treatment might be discontinued. Until the evidence base is enhanced by the findings of large-scale, randomised controlled discontinuation trials of ChEIs and memantine that use multiple, clinically relevant, cognitive, functional and behavioural outcome measures, clinicians' prescribing decisions involve balancing the risks of discontinuation with side effects and costs of continued treatment. Such decisions must be highly individualised and patient-centred.