If someone you know has Alzheimer’s disease or vascular dementia, they may be experiencing a variety of non-memory-related symptoms, including aggressiveness, agitation, delusions, and hallucinations. To address these challenging symptoms, doctors often prescribe antipsychotic medications.

But the adverse events associated with antipsychotic use can be dangerous, especially in older adults. To warn people of these risks, the Food and Drug Administration (FDA) issued a black box warning for all antipsychotic medications.

Black Box Warning

Black box warnings are the most serious warnings the FDA issues. They warn doctors and patients about serious or life-threatening adverse drug reactions. Antipsychotics earned a black box warning because they are associated with increased rates of stroke and death in older adults with dementia.

Antipsychotics With Black Box Warnings

Both typical and atypical antipsychotic medications come with a black box warning. Below are just a few antipsychotic medications commonly prescribed for use in older adults with dementia.

Antipsychotic Black Box Warning (full text)

Keep in mind that all antipsychotics come with a black box warning, not just those listed below.

Atypical Antipsychotics

Atypical antipsychotics are frequently used off-label to treat the mood and behavioral symptoms associated with dementia. Commonly prescribed atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Geodon (ziprasidone)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)

Typical Antipsychotics

Typical antipsychotics may also be prescribed for off-label use. Common typical antipsychotics for dementia include:

  • Haldol (haloperidol)
  • Navane (thiothixene)
  • Trilafon (perphenazine)

Typical antipsychotics tend to cause extrapyramidal symptoms—such as stiffness and immobility—and metabolic syndrome. Therefore, these drugs are rarely, if ever, prescribed for use in adults with dementia.

Why Antipsychotics Are Still Used

Psychosis and agitation in dementia can cause considerable distress to an older person or to their caregivers. Because there are a limited number of medications that can treat this condition, your loved one’s doctor may still use one or more antipsychotic medications that carry this black box warning. In a situation like this, the doctor will consider whether the potential benefits of using these medications are greater than the risks.