Getting medication for dementia

When should drug treatments be prescribed?

Non-drug approaches can be very effective in reducing changes in mood and behaviour. However in some cases they don’t help the person.

If the person's problems continue to cause them severe distress or put them or others at risk of physical harm, a doctor may need to prescribe medication. Even then, drugs should always be used alongside individualised support and non-drug approaches, based on the person’s needs.

If a doctor decides that a certain drug might be helpful, they should discuss this with the person where possible, and ideally also with their carer. They should explain which specific problems the drug is being used to treat and any risks associated with taking it.

Starting medication

People who choose to take medication for their dementia usually start taking them soon after being diagnosed. Their decision to do so should be informed by a discussion with the specialist and, ideally, a person who can support them.  

For most people, this happens at a local memory service or neurology clinic. Sometimes, a specialist will write to a person’s GP or nurse prescriber to ask them to start prescribing the medication. 

Before prescribing donepezil or another cholinesterase inhibitor, the doctor should check the person’s pulse (or heart rate) and blood pressure to make sure it’s safe for them to take the medication. If the person already has a slow heart rate or other heart problems, taking the medication could increase their risk of fainting and potentially injuring themselves. 

Getting the right dose and form of medication 

Starting on too high a dose of medication can make side effects worse, so it’s best to start with a low dose and gradually increase it over a few weeks. Once the person has settled on a medication and dose that works for them, the GP will usually take on the role of prescribing. 

Medications can come in lots of different forms, such as: 

• Pills
• Liquids
• Skin patches

Getting the form of medication that works best for you makes it much easier to take the right dose at the right time. This can involve a discussion between the person with dementia, the family carer (where available), the doctor and the pharmacist.

Most people will be offered their medication in tablet form, unless they are unable to take them. A common reason for switching to a different form is if they have problems swallowing. When this happens, it may be easier and safer for the person to try an oro-dispersible tablet, which dissolves under their tongue, or a patch that delivers a drug slowly through the skin. 

Medication for other health conditions

Some medications for other health conditions can have the opposite effect to those taken for dementia. For example, they may cause confusion or drowsiness. As a result, they can make the symptoms of dementia worse. 

It’s important to tell the GP or memory service about any medications the person is taking to treat: 

• urinary incontinence and other bladder problems
• anxiety or depression
• allergies or hay fever – particularly those that cause drowsiness
• hallucinations, delusions or severe agitation
• excessive drooling or sweating
• the symptoms of Parkinson’s disease
• nausea and sickness
• long-term pain. 

Many medications used to treat these conditions will be safe and effective and will not affect a person’s dementia symptoms. However, some may not be suitable and will need to be changed or stopped. It’s essential to speak to a doctor or pharmacist before stopping a prescription medicine. 

Reviewing medication 

If at any time a person feels that taking medication for their dementia is no longer the right choice for them, they can talk to their doctor about reviewing the treatment. 

Their GP, or a pharmacist working at the GP practice, should also regularly review the person’s medication to check how well they are working. This includes whether the medications are helping the person to function better in everyday life, if they are helping their mental abilities, and if they are causing unpleasant side effects. 

If a medication doesn’t seem to be helping, or the benefits are not worth the side effects, then the person may wish to consider other options. This could be changing to another medication, reducing the dose, or stopping it altogether. The GP may need to involve a dementia specialist, such as the memory service, to make changes to prescribed medication.