If an antipsychotic is considered necessary for agitation, aggression or psychotic symptoms associated with Alzheimer disease or mixed Alzheimer disease and vascular dementia (i.e. dementia that is not associated with Lewy bodies or Parkinson disease):

Antipsychotic Regular dose
Risperidone* Initially 0.25 mg orally, twice daily.
Increase if needed by 0.25 mg every two or more days.
Maximum of 2 mg daily in one or two divided doses.

OR

Olanzapine† Initially 2.5 mg orally, daily.
Increase if needed by 2.5 mg every two or more days.
Maximum of 10 mg daily in one or two divided doses.

If an antipsychotic is considered necessary for agitation, aggression or psychosis of dementia associated with Lewy bodies (i.e. rivastigmine or donepezil is inadequate):

Regular dose
Quetiapine† Initially immediate-release 12.5 to 25 mg orally, once or twice daily. Increase if needed by 12.5 to 25 mg daily every two or more days.
Maximum of 75 mg twice a day.

* Risperidone is the only antipsychotic approved by the Therapeutic Goods Administration (TGA) for support of responsive behaviours in Australia; this approval is for a maximum of 12 weeks treatment in people with moderate to severe Alzheimer’s disease.

† Like all antipsychotics aside from risperidone, in Australia olanzapine and quetiapine are not TGA-approved for supporting responsive behaviours.

  • Non-pharmacological strategies must be trialled first and maintained throughout all stages.
  • Antipsychotics are NOT first-line.
  • Use antipsychotics with extreme caution in people with dementia with Lewy bodies or Parkinson's disease dementia.
  • Use the lowest effective dose for the shortest period of time.

Restrictive practices must only be used as a last resort and in the least restrictive form. Where restrictive practices are used, approved providers must meet a number of conditions:

  • Document the alternatives that have been considered and used prior, and why they have not been successful.
  • Work within a framework to ensure informed consent for the restrictive practice has been obtained from the consumer or their restrictive practice substitute decision maker.
  • Contribute to a monitoring plan for the consumer to recognise and respond to any for signs of distress or harm, side effects and adverse events, changes in wellbeing, as well as independent functions or ability to undertake activities of daily living.
  • Review the use of restrictive practice regularly with the aim to removing it as soon as possible or practicable.
  • A Behaviour Support Plan must be in place for every consumer who exhibits changed behaviours or who has restrictive practices considered, applied or used.

Refer to the Australian Government, Department of Health and Aged Care Quality and Safety Commission websites for the latest information.