Section F Ongoing use of medication: monitoring and reviewing
Reduction of inappropriate medication
NICE guidelines1 say that antipsychotic medication should not be the first or only intervention for challenging behaviour and should only be given, if appropriate, alongside psychological or other interventions. A similar approach should be used for the other psychotropic drugs. Some people are prescribed medication for ‘challenging behaviour’, even though prescribing guidelines2 state that ‘challenging behaviour’ is not a specific enough reason to prescribe medication.
Lots of people with a learning disability, autism or both are prescribed too much psychotropic medication, or medication that is inappropriate for their needs.
Because of this, it is not unusual for carers or families to want to reduce or stop some of the medication their relatives are taking.
If you are thinking about whether your relative is prescribed too much psychotropic medication and it could be reduced or stopped, you may need to identify some specific reasons for this change.
Reasons to reduce or stop medications could include:
- Their medication is ineffective, as it is not helping them and the problem or behaviour has persisted. Prescribing guidelines explain that if the problems the medication was prescribed for do not improve within three months, then the medication should be reduced and stopped.
- Their medication is intended only as a short term measure.
- They are taking more medication than necessary.
- The side effects of their medication are too serious for it to be continued.
- Even though their medication is partly or fully effective, you want to explore an alternative form of therapy or support that could be as effective, or more effective.
- Your relative may have been on medication for a long time without review or monitoring.
- Your relative may take multiple medications which could interact with negative effects for your relative.
If your relative takes more than one medication that you think is unhelpful, you should keep in mind that only one medication would usually be reduced at a time and the prescriber may need to plan around any interactions between medications.
I think that it is best for my relative to have some of their medication reduced or withdrawn: What should I do now?
If you think that your relative should have one (or more) medications reduced or withdrawn, the next step is to find some reliable information about the medication your relative is taking and the withdrawal process. You can find information from your doctor, the information on the leaflet that comes with the medication and on the Mind website. See Section C for more suggestions about finding information about medication.
Go to the next medication review or ask for a meeting to discuss the medication with the prescriber. You may want to invite other people, such as your relative’s teacher or care service manager.
If you are not confident about the medical advice you are being given, you can ask for a second doctor to assess your relative and give their views on the best treatment. This could be a useful way of challenging a medical decision that you disagree with.
If you have problems talking to the provider or they do not agree with your wishes to reduce or stop medication, you can ask that the best interests process is followed to make a decision. See the information about decision making principles under the Mental Capacity Act (2005) in Section D.