Appropriate Use of Antipsychotic Medications

Antipsychotic medications are used extensively in nursing facilities (NFs). When used for approved disease states - such as schizophrenia, Huntington's disease and Tourette's syndrome - their clinical benefits are widely accepted. In people with a predetermined or long-standing history of mental illness, the chronic use of an antipsychotic medication also may be deemed necessary to stabilize and improve functionality. Antipsychotic medications have been frequently used “off-label” in Alzheimer's disease and other dementia-related illnesses where the effectiveness of the treatment can show mixed results. The off-label use of antipsychotic medications for dementia-related illnesses is unsupported in the literature. However, in 2023, the FDA approved the use of the antipsychotic Rexulti® to treat agitation related to Alzheimer’s disease. The physician must consider the risks versus benefits before prescribing this medication, and non-pharmacological interventions should be the first line treatment in these situations.

In older adults with dementia, antipsychotics are only appropriate in a small number of instances. Yet, despite the Food and Drug Administration's black box warnings of increased mortality, the inappropriate use of antipsychotics as a chemical restraint in people living in Texas NFs who have dementia still persists. Significant risks - including higher blood sugar and cholesterol levels, weight gain, increased risk of falls, and decreased cognition - also are associated with the use of antipsychotics. These complications can lead to the worsening of other primary diagnoses. Rexulti® retains that black box warning, despite the new FDA approval for Alzheimer’s-related agitation.

Visit the Quality Monitoring Program’s Alzheimer’s Disease and Dementia Care web page for best practices in caring for people with Alzheimer’s disease or related disorders.

Music and Memory

Some Texas NFs have begun using individualized music playlists with patients who have Alzheimer's and other memory disorders to try to reduce the use of antipsychotic medication.

The HHS Music and Memory program began in 2015 with 32 NFs, later expanding to over 600 facilities across the state. The goal is to help people with Alzheimer’s disease or other forms of dementia reconnect with the world through specific, music-triggered memories. Family members and NF staff create personal playlists for use on digital music players, such as iPods.

Visit the Music and Memory webpage to learn how you can introduce this program to your facility.

Best Practices

Resources Created by HHS

Resources from the Centers for Medicare & Medicaid Services

Resources from Other Organizations