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Alzheimer’s disease affects more than just memory for some people. It can also lead to feeling unusually irritable, agitated, and restless.
Agitation in Alzheimer’s can look like pacing, repeated movements, or verbal and physical aggression that can sometimes lead to resisting care. Irritability may appear as becoming upset more easily than usual in everyday situations. Both can happen alongside each other.
These changes can be challenging if you’re living with Alzheimer’s or caring for someone who has it. The good news is that there are many ways to help, including medications recommended by a healthcare provider.
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Two medications are approved by the U.S. Food and Drug Administration (FDA) for agitation related to dementia due to Alzheimer’s: brexpiprazole (Rexulti) and dextromethorphan-bupropion (Auvelity).
Brexpiprazole is an atypical antipsychotic and the first medication FDA-approved for agitation related to dementia due to Alzheimer’s. It’s a tablet taken once a day with or without food. The dose is increased gradually to a recommended target of 2 milligrams once a day. It may be increased to 3 milligrams if needed.
Clinical studies have shown that the 2-milligram and 3-milligram doses of brexpiprazole significantly reduced Alzheimer’s-related agitation compared to a placebo (an inactive treatment). The studies found significant improvements after 12 weeks of treatment.
The most common side effects in people taking brexpiprazole for Alzheimer’s-related agitation include headache, dizziness, urinary tract infections, nasopharyngitis (inflammation of the nose and throat), and sleep problems.
Brexpiprazole carries a serious warning about its use in older adults with dementia-related psychosis. Psychosis is different from Alzheimer’s-related agitation and irritability. Dementia-related psychosis can involve hallucinations (seeing or hearing things that aren’t there) or delusions (strong beliefs that aren’t true).
Antipsychotic medications, including brexpiprazole, carry a boxed warning because they can increase the risk of death in older adults with dementia-related psychosis. Brexpiprazole is still FDA-approved specifically for agitation related to dementia due to Alzheimer’s disease.
On April 30, 2026, the FDA approved Auvelity to treat agitation related to dementia due to Alzheimer’s disease. Auvelity is an extended-release tablet containing dextromethorphan and bupropion. It’s the first FDA-approved nonantipsychotic medication for this use.
Dextromethorphan-bupropion is a tablet that’s taken once daily for the first seven days, then twice daily. The dose may be increased again after 14 days, depending on how well the person tolerates the medication.
It combines two commonly used medicines that work together in the brain to ease agitation. Clinical studies show dextromethorphan-bupropion significantly reduced agitation related to Alzheimer’s compared with a placebo. Significant improvements were seen after five weeks of treatment.
Additionally, one study showed that people who continued taking dextromethorphan-bupropion went longer before their agitation symptoms returned compared with people who switched to a placebo. This suggests that continuing treatment may help delay the return of agitation symptoms.
In studies of people with agitation related to Alzheimer’s, the most common side effects of dextromethorphan-bupropion were dizziness and indigestion.
Before starting dextromethorphan-bupropion, your healthcare provider may ask you about any personal or family history of mental disorders. Dextromethorphan-bupropion carries a boxed warning about an increased risk of suicidal thoughts and behaviors in children and young adults taking antidepressants.
For adults with Alzheimer’s, healthcare providers should still monitor for changes in mood and behavior.
Dextromethorphan-bupropion also has other important risks. It can raise blood pressure and increase the risk of seizures. It may also trigger mania or hypomania in some people with bipolar disorder.
Before treatment, healthcare providers should check blood pressure, ask about a history of bipolar disorder, and review other medicines that contain bupropion or dextromethorphan.
Some medications used to treat agitation related to Alzheimer’s are prescribed off-label. This means a medication is being used for a purpose that’s different from its FDA-approved use. However, this doesn’t necessarily mean the medication is unsafe.
Treatment should be tailored to each person. A person’s overall health, along with the medication’s possible benefits, side effects, and drug interactions, should all be considered before starting treatment.
Antidepressants may sometimes be considered for agitation in Alzheimer’s disease, even when the person doesn’t have depression. Commonly used antidepressants in Alzheimer’s are:
Citalopram has the strongest evidence among these antidepressants for reducing agitation in Alzheimer’s. It may also cause diarrhea, heart rhythm changes, and decreased appetite. It’s important for healthcare providers to weigh the possible risks against the benefits.
Several antipsychotic medications have been studied for agitation related to Alzheimer’s. Commonly used antipsychotics in Alzheimer’s are:
Antipsychotics can increase the risk of serious health problems in older adults. They’re generally reserved for situations in which symptoms cause severe distress or pose a risk of harm to the person or others, especially when other approaches haven’t helped.
Some providers may consider medications outside of antidepressants and antipsychotics to help treat agitation. These medications shouldn’t be viewed as standard treatments for everyone with agitation related to Alzheimer’s.
Memantine and cholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, may help improve overall behavioral symptoms, including agitation, but the evidence is mixed.
Benzodiazepines such as lorazepam may be used short term in some people, but the evidence is also mixed. In older adults, benzodiazepines can cause confusion and increase the risk of falls, especially with long-term use.
A sudden behavior change may be the result of Alzheimer’s or other treatable causes. For example, pain, infection, dehydration, and constipation are treatable causes that can trigger agitation.
A new medication or drug interaction can also cause side effects that may look like behavioral changes. It’s important to have a thorough medical evaluation when behavioral symptoms appear.
Healthcare providers should also distinguish agitation from other conditions, such as:
If agitation is caused by another condition or a treatable cause, it may help to try a change in routine, sleep, or the environment rather than adding medication.
The Alzheimer’s Association recommends using nonmedication treatment options first when appropriate. Some helpful strategies may include:
These strategies may help and can also be used alongside medications when prescribed.
After a medication is started, healthcare providers should monitor how well it’s working and if any side effects appear. The dose may need to be increased gradually to find the amount that works best.
For caregivers and families, one of the most important things to remember is that there isn’t one single medication that works for every person with Alzheimer’s. It may take a while to find the medication that works best, and treatment may need to be adjusted along the way.
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