Deprescribing antipsychotics in long term care patients with dementia

To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with  behavioral disturbances that includes prescribing and deprescribing criteria and to assess its  applicability in longterm care institutions.

The protocol was developed from an interdisciplinary perspective based on a literature  search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to  the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study  with a follow-up of 6 months after the intervention study.

A protocol was developed that includes prescribing and deprescribing criteria. The  intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was  completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7  (20%). Treatment was  resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that  there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in  combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in  improving the use of these drugs in elderly dementia patients in long-term care institutions.