Psychosis & related disorders
Antipsychotics are inappropriate to use in patients aged 65 years or over
- other than quetiapine or clozapine in those with parkinsonism or Lewy Body Disease (risk of severe extra-pyramidal symptoms)
- in patients with behavioural and psychological symptoms of dementia (BPSD) unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke)
- as hypnotics, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extra-pyramidal side effects, falls)
- if neuroleptic with moderate-marked antimuscarinic/ anticholinergic effects (chlorpromazine, clozapine, flupenthixol, fluphenzine, pipothiazine, promazine, zuclopenthixol) and patient has a history of prostatism or previous urinary retention (high risk of urinary retention)
- phenothiazines should not be used as first-line treatment, since safer and more efficacious alternatives exist (phenothiazines are sedative, have significant anti-muscarinic toxicity in older people, with the exception of prochlorperazine for nausea/vomiting/vertigo, chlorpromazine for relief of persistent hiccoughs and levomepromazine as an anti-emetic in palliative care )
- if patient has a history of falls (may cause gait dyspraxia, Parkinsonism).
For people with learning difficulties initiate treatment with low doses and titrate cautiously with frequent monitoring for side effects
Additional resources
KMPT Depot Prescription and Administration Chart
KMPT guideline for the use of high dose antipsychotics
KMPT Use of IM injection in community mental health clinics
NICE CG178 Psychosis and schizophrenia in adults: prevention and management
BMJ Best Practice: Neuroleptic malignant syndrome