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Antipsychotic drugs are being prescribed to patients with dementia outside of guidelines from the National Institute of Health and Care Excellence (NICE), according to a study.
Results of a retrospective cohort study, published in the October 2025 edition of The Lancet Psychiatry, found that patients were prescribed initial antipsychotic treatment for a median of seven months, exceeding NICE’s recommendation of one to three months.
Researchers analysed UK primary care data from 9,819 people living with dementia, aged 60–85 years, who received their first antipsychotic prescription between 2000 and 2023.
18.1% of patients were initiated on a prescription above the minimum effective dose, the study found.
Antipsychotics involved in the study included haloperidol, olanzapine, quetiapine, risperidone, and other typical and atypical drugs, such as clozapine, aripiprazole or chlorpromazine, which were prescribed orally.
“Of the 1,781 participants who started on a moderate or high dose, 519 (29.1%) had a moderate or high dose in all quarters of the first year of treatment,” the authors said.
The study results also revealed that one year after treatment initiation, 5,136 (78.3%) of 6,559 eligible patients remained on medication: 48.9% of patients (95% confidence interval [CI] 47.7–50.1) were on a low dose of haloperidol, olanzapine, quetiapine or risperidone; 14.8% (CI 13.9–15.6) on a moderate or high dose of haloperidol, olanzapine, quetiapine or risperidone; and 14.6% of patients (CI 13·8–15·5) were on other antipsychotics.
“These findings suggest that, despite well-intentioned policy, prescribing of antipsychotics for people with dementia still tends to go on longer than is advised and at higher doses than recommended, raising concerns about avoidable harms such as mortality, stroke and pneumonia,” the authors added.
“The persistence of these patterns indicates that guidance on its own is not enough. Stronger systems to help clinicians and carers make safer choices are needed, which include regular medication reviews built into dementia care, closer oversight from regulators and greater investment in evidence-based psychosocial approaches that can reduce reliance on medication.”
Anne Child, pharmacy and dementia specialist lead at the Royal Masonic Benevolent Institution Care Company, commented that the study results were a “cause for concern”.
“All too often [antipsychotic drugs] are used as first-line treatment, ahead of non-drug therapies, with delay in review, because the behaviour is focused on [this] instead of the person.”
“Of course, for some individuals, they are the appropriate intervention but for many, especially those in long-term care, the importance of life-long patterns, interests, activities and drivers of wellbeing must be much more carefully considered, care planned and supported,” she said.
“Psychosocial interventions need to be invested in, accessible, valued and embraced as part of the choice of interventions available to individuals living with this condition.”
Ian Maidment, professor in clinical pharmacy at Aston University, said: “This is an important study and shows that the use of antipsychotics for behaviour that challenges in dementia continues to be an issue.
“This is despite a national drive to reduce prescribing following the Banerjee report, ‘Time for Action’, about 15 years ago. This is a cause for concern, because the Banerjee report estimated that antipsychotics caused an additional 1,800 deaths every year.
“Pharmacy staff have a key role to ensure the appropriate use of antipsychotics. It is vital that a holistic approach is adopted to medication reviews and that similar equally risky medication used for behaviour that challenges in dementia, such as benzodiazepines, are also reviewed.”
