The short answer
Antipsychotic drugs such as quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa) and haloperidol (Haldol) carry an FDA boxed warning of increased risk of death in elderly people with dementia. Federal rules allow psychotropic drugs only when needed to treat a specific, documented condition, require attempts to reduce the dose, and limit "as needed" orders to 14 days unless the prescriber documents why a longer order is appropriate.
Signs of overmedication
- Sudden or excessive sleepiness, or the resident "not like herself"
- New falls, unsteadiness or shuffling
- Drooling, stiffness or tremors
- Poor appetite, weight loss or trouble swallowing
- Withdrawal and loss of interest
What the rules require
- A psychotropic drug may be given only if necessary to treat a specific condition diagnosed and documented in the record.
- The facility must attempt gradual dose reductions and use behavioral approaches, unless clinically contraindicated.
- "As needed" (PRN) psychotropic orders are limited to 14 days unless the prescriber documents the rationale; PRN antipsychotics require a new evaluation to renew.
- Residents may not receive unnecessary drugs, including drugs in excessive doses, for excessive duration or without adequate monitoring.
Questions to ask
- What diagnosis is this medication treating, and who prescribed it?
- What non-drug approaches were tried first?
- When is the next attempt to reduce the dose?
- Why was I not told before it was started?
Check the MAR for how often PRN sedatives are actually given. Each facility's antipsychotic use rate is a Medicare quality measure.
The rules behind this
- 42 C.F.R. § 483.45(d)–(e) (unnecessary and psychotropic drugs)
- 42 C.F.R. § 483.10(e)(1) (chemical restraints)
Related questions
This guide provides general information, not medical or legal advice. Rules change; confirm current requirements with the facility, the New York State Department of Health or a professional. Attorney Advertising.