Section F Ongoing use of medication: monitoring and reviewing
NICE guidelines recommend that if an antipsychotic medication is being prescribed for challenging behaviour, the effectiveness of the medication and side effects should be reviewed after three to four weeks. If there has been no improvement after six weeks, the guidance recommends that the medication should be safely withdrawn, and other interventions considered.
The importance of regular reviews is also highlighted by Royal College of Psychiatry practice guidelines. These explain that for any psychotropic medication, if the medication has not led to an improvement in three months, then the medication should be safely withdrawn.
According to these guidelines, once your relative has started to take medication you should meet with your doctor after three to four weeks and then two months (at most) later. It might be helpful to book these appointments in advance when the medication is started.
Questions to ask:
During a medication review you could discuss the following questions with the doctor, as well as anything else you would like to raise.
- Is the medication making a positive difference?
- Is your relative experiencing any side effects?
- If your relative is experiencing side effects, how can these be addressed?
- What alternative interventions could also be helpful alongside medication?
- Is your relative finding it easy to take the medication?
- Have there been any changes to your relative’s physical health?
- Is the medication needed at all?
- What is the plan for eventual reduction or withdrawal of medication?
In order to fully understand any effects of the medication and side effects, it can be useful to keep a record of your relative’s behaviour and any potential side effects. Before starting medication, your relative should have had a baseline behaviour recording. By regularly using the same method of recording behaviour once they have started medication, you can build a picture of whether there has been any change in their behaviour. For more information about recording behaviour, see Section C.
It is also important to keep monitoring your relative’s physical health, such as their weight, so that any changes can be raised with the doctor.
Once these questions have been discussed, you should decide the next steps with the doctor. This will depend on whether the medication is benefiting your relative, and any other effects the medication may be having. You could consider whether the following steps would be appropriate for your relative:
- If the medication is benefiting your relative with manageable side effects, your relative could continue to take the medication.
- If your relative is benefiting from the medication but there are concerning side effects, your doctor could suggest methods of reducing those side effects while carrying on taking the medication.
- You may want to ask the doctor to adjust the dose of the medication.
- You could ask the doctor to consider alternatives to the medication, such as a different medication or a non-medication alternative.
- An outcome of all medication reviews should be to agree on when the next review will be and how your relative will be monitored in the meantime.