Medicines for agitation and behavior

Many people living with dementia go through times of agitation. They may pace, yell, refuse care, or push or hit. This is hard for everyone, and it is natural to hope a pill will fix it.

Medicines can help some people. But they also carry real risks, and the benefit is often small. This page explains what to try first, which medicines doctors use, and what questions to ask before saying yes.

Start with the reason behind the behavior

Agitation is often a sign that something is wrong, and the person cannot say what. Common causes include pain, constipation, an infection, poor sleep, or trouble seeing or hearing.⁹ A new medicine, or a mix of medicines, can also cause confusion and agitation in older adults.⁹

The setting matters too. Noise, crowds, a rushed bath or being touched without warning can feel scary. The Alzheimer's Association advises trying non-drug approaches first, every time.⁴ These include finding the trigger, making the space calmer, checking comfort, not arguing, and gently turning attention to something else.⁴

The evidence backs this up. A large review pooled 163 trials with more than 23,000 people with dementia. Outdoor activity, massage and touch (with or without music), and care from a team of different professionals all reduced aggression and agitation by a lot.⁶ Older antipsychotics such as haloperidol did no better than usual care.⁶ Many of the trials had flaws, so the exact sizes are uncertain.⁶

For step-by-step help, see Agitation and aggression, Sundowning and the behavior diary. A diary of what happened before, during and after each episode helps the doctor too.

When doctors consider medicine

Medicine may make sense when non-drug steps have been tried consistently and have not worked. It may also make sense when the person is very distressed or could harm themselves or others.^4,9

Good practice is to aim at one clear symptom, start with one medicine at a low dose, and watch closely for side effects.⁴ Your doctor starts low and goes slow. The plan should also say how you will judge whether it helps, and when to try stopping it.⁹

Medicine should never be used just to make a person sleepy or easier to manage.⁴

Brexpiprazole (Rexulti)

In May 2023, the FDA approved brexpiprazole for agitation linked to Alzheimer's dementia. It was the first medicine approved for this use.¹ It is an atypical antipsychotic (a newer type of medicine first used for schizophrenia and other mental illnesses).

What the studies showed. Two 12-week trials included people aged 51 to 90 with Alzheimer's dementia and agitation.¹ About 500 people took brexpiprazole and about 250 took a placebo (a look-alike with no medicine).² Agitation scores improved more on the medicine than on placebo.¹ But a review for family doctors called the extra benefit minimal and said it may not be noticeable.⁵

Side effects. In the agitation trials, the most common ones were headache, trouble sleeping, sleepiness, dizziness, colds and urinary tract infections.² Weight gain and higher blood sugar can also happen.⁵ Like all antipsychotics, it can cause falls and uncontrolled movements that may not go away.²

The warning. Brexpiprazole carries the same boxed warning as other antipsychotics: older people with dementia have a higher risk of death.^1,2 It is not approved for dementia-related psychosis (seeing or believing things that are not real) without agitation.²

Cost. In 2024, a month's supply cost about $1,500 at retail price before insurance.⁵ What you pay depends on your Part D or other drug plan. See paying for dementia medicines and Medicare in dementia.

Dextromethorphan-bupropion (Auvelity)

On April 30, 2026, the FDA approved Auvelity for agitation linked to Alzheimer's dementia in adults.³ It is the first approved medicine for this use that is not an antipsychotic.³ It was already approved in 2022 for depression in adults.³

It combines two older medicines. Dextromethorphan is a cough-medicine ingredient that also acts on brain signals. Bupropion is an antidepressant.

What the studies showed. In a 5-week trial, agitation improved more on Auvelity than on placebo.³ In a second trial, people who had improved were switched to either Auvelity or placebo. Those who stayed on Auvelity went longer before agitation came back.³

Side effects. Common ones include dizziness, upset stomach, headache, diarrhea, sleepiness, dry mouth and heavy sweating.³ It can raise blood pressure and can cause seizures. It can also set off mania (an extreme high mood) in people at risk.³ Its boxed warning is about suicidal thoughts in young people, which applies to all antidepressants.³

Before starting. The doctor should check blood pressure and ask about bipolar disorder in the person or family.³ Tell the doctor about any other product that contains bupropion or dextromethorphan, including over-the-counter cough medicine.³ As of October 2026, it is new for this use, so ask your pharmacist about your plan's coverage.

Other antipsychotics and the boxed warning

Doctors sometimes prescribe other antipsychotics "off-label" (for a use the FDA has not approved). These include risperidone, quetiapine, olanzapine, aripiprazole and haloperidol.⁴

All antipsychotics carry the FDA's strongest warning, a boxed warning, for older people with dementia.^2,9 Here is what it is based on:

That works out to about 2 extra deaths for every 100 people treated for 10 weeks. Most deaths were from heart problems or infections such as pneumonia.² Some of these medicines have also been linked to more strokes, including fatal strokes, in older people with dementia.²

Other risks include sleepiness and confusion that lead to falls, weight gain, diabetes, and shaking or stiff movements that may be permanent.⁹

If an antipsychotic is used, it should be at the lowest dose for the shortest time, with close follow-up.⁴ Ask the doctor to set a date to check whether it can be lowered or stopped.⁹

Citalopram and other antidepressants

Citalopram (Celexa) is an SSRI antidepressant. It is not FDA-approved for agitation, but some doctors prescribe it.⁴

A trial called CitAD tested it in 186 people with Alzheimer's and agitation over 9 weeks.⁷ About 40 in 100 people on citalopram improved a moderate or large amount. On placebo, about 26 in 100 did.⁸ So about 1 in 7 extra people improved because of the medicine.

There were downsides. Citalopram slowed the heart's electrical recharge between beats (called QT prolongation), which can lead to a dangerous rhythm.⁷ Thinking got a bit worse, and some people had falls, diarrhea or poor appetite.⁷ The FDA already warns about QT changes with citalopram and sets a lower top dose for people over 60.⁷

Antidepressants may make the most sense for a person who also seems depressed or anxious.⁹ Others, such as sertraline and trazodone, are sometimes used too.⁴ See Apathy and depression in dementia.

Why benzodiazepines are usually avoided

Benzodiazepines are sedatives (calming drugs). Examples are lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium) and clonazepam (Klonopin).

The American Geriatrics Society says not to use them as a first choice for agitation in older adults.¹⁰ Its Beers Criteria, a list of risky medicines for older people, suggests avoiding them.¹¹ In older adults, people who used these drugs were:¹¹

• about 5 times more likely to have memory problems
• about 4 times more likely to be drowsy during the day
• about twice as likely to fall and break a bone
• about twice as likely to have a car crash

The body also gets used to them, so they stop working as well, and they can be habit-forming.¹¹ Some doctors still prescribe them, such as lorazepam, for anxiety and restlessness.⁴

Do not stop a benzodiazepine suddenly. That can cause withdrawal. Talk with the doctor about lowering it slowly.¹¹ See Medicines that can worsen memory and Sleep medicines in dementia.

Questions to ask the doctor

Before starting a medicine

• What do you think is causing the behavior? Have we checked for pain, infection and constipation?
• Could one of the current medicines be part of the problem?
• What exact symptom is this medicine for? How will we know if it works?
• What are the most likely side effects for this person, given their heart, falls and other health problems?
• What does it cost on our plan?

After starting

• When will we check whether it is helping?
• What side effects should make us call you the same day?
• When can we try lowering or stopping it?

Talk with your doctor or pharmacist before changing anything. For help keeping track of pills at home, see Managing medicines at home.

When to get help

Call the doctor soon if agitation starts suddenly or gets much worse over hours or days. A quick change can be a sign of delirium (sudden confusion from an illness), an infection or a medicine problem.⁹ See Hospital stays.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.