Alzheimer’s disease (AD), the most common type of dementia, can lead to dementia-related agitation, such as feeling anxious or getting upset easily. Other symptoms can include restlessness, trouble sleeping, or pacing back and forth. Agitation is a common and troubling symptom. It can lower the quality of life for people with AD and also their caregivers.
Treatment options for dementia-related agitation are limited and often involve a type of medicine known as an antipsychotic. Unfortunately, antipsychotics have serious risks for older people, including an increased risk of death. In April 2026, the FDA approved the first non-antipsychotic medicine for dementia-related agitation due to AD, Auvelity (dextromethorphan/bupropion).
Continue reading to learn more about Auvelity, including how it is thought to work for dementia-related agitation, how to take it, and its benefits.
How Does Auvelity Work for Dementia-Related Agitation?
Researchers are still learning exactly how Auvelity works for dementia-related agitation due to Alzheimer’s disease. Auvelity has two medicines working together in one tablet: bupropion and dextromethorphan.
Dextromethorphan acts on certain receptors that seem to affect how brain cells talk to each other. Bupropion seems to have two roles. It acts on brain chemicals in ways that may help reduce agitation. Bupropion also helps keep dextromethorphan active in your body longer by slowing down the rate at which your body breaks it down.
Together, these two medicines may help reduce dementia-related agitation in people with Alzheimer’s disease.
How Do I Take Auvelity for Dementia-Related Agitation?
Auvelity comes as an extended-release tablet and is typically taken twice a day, with or without food. You should swallow Auvelity tablets whole, without chewing, crushing, or breaking them. To help your body adjust to the medicine, the dose is usually increased gradually over the first couple of weeks.
For dementia-related agitation due to Alzheimer’s, here’s the typical dosage schedule for starting Auvelity (if you tolerate the medicine well):
- Days 1 through 7: One Auvelity 30 mg/105 mg tablet taken once daily in the morning
- Days 8 through 14: One Auvelity 30 mg/105 mg tablet taken twice daily, at least eight hours apart
- Maintenance dosage (day 15 and on): One Auvelity 45 mg/105 mg tablet taken twice daily, at least eight hours apart
Some people process medicines differently because of inherited differences in certain enzymes. One of these enzymes is called CYP2D6, which helps break down many medicines in the body. Some people are “CYP2D6 poor metabolizers,” which means they break down certain medicines more slowly and may need a lower dose of these medicines. Ask your health care provider whether this test is right for you or your loved one before starting Auvelity.
Dose adjustments may also be needed if your kidneys are not working properly or if you take certain other medicines that affect how Auvelity is broken down in the body. Tell your health care provider if you have kidney problems. Your health care provider may do a lab test to see how well your kidneys are working. Be sure to keep any appointments, including those for lab tests.
Tell your health care provider about all of the medicines and supplements you take and any health conditions you have. Note that the Auvelity dosage described above is standard dosing that appears on the product labeling. Your dosing may be different from what is described here. Always take your medicine as recommended by your health care provider.
If you miss a dose of Auvelity, do not take an extra dose to make up for the missed dose. You should wait and take your next dose at the regular time. You should not take more than one dose of Auvelity at a time, and you should not take more than two tablets in a day. If you miss a dose and are not sure what to do, ask your pharmacist or other health care provider.
How Was Auvelity Studied for Dementia-Related Agitation?
Two main studies tested whether Auvelity helped lessen dementia-related agitation in people with Alzheimer’s disease. One study looked at short-term benefits over five weeks. The other study looked at benefits over about six months. Patients in both of these studies met the following criteria:
- Diagnosis of Alzheimer’s disease
- Diagnosis of agitation with moderate-to-severe agitation symptoms that required medicine
- Mini-Mental Status Exam (MMSE) score between 10 and 24: MMSE is a short test used to assess your thinking and memory skills. It looks at things such as how well you remember information, pay attention, and solve simple problems. The test is scored out of 30 points. Higher scores mean your thinking and memory are generally working well. Lower scores suggest there may be some concerns with thinking or memory.
- Score of 4 or higher on the agitation/aggression section of the Neuropsychiatric Inventory. Scores for this section range from 0 to 12, with higher scores being linked to increased severity of symptoms.
Study 1
The primary goal of the five-week study was to measure the change in the Cohen-Mansfield Agitation Inventory (CMAI) Score. This measures how often a person shows agitated behaviors, based on what a caregiver observes. Scores range from 29 (no symptoms) to a maximum of 203. Higher scores mean more severe agitation-related and disruptive behaviors. If scores go down with treatment, it suggests improvement in agitation symptoms.
Study participants were randomly assigned to take Auvelity or a placebo (no medicine in it) for five weeks. Neither the study participants nor the investigators knew which treatment participants were receiving. The middle age of participants was 75 years, ranging from 65 to 90 years. About 56% of participants were female, and the rest were male. About 86% of participants were White, about 12% were Black, and about 1% were Asian.
Study 2
The primary goal of the six-month study was to see how long it took for agitation symptoms to return after stopping Auvelity. In this study, people who were already doing well on Auvelity were divided into two groups. About half of the participants kept taking Auvelity. The other half stopped Auvelity and started taking a placebo (no medicine in it). Neither the study participants nor the investigators knew which treatment participants were receiving. The middle age of participants was 73 years, ranging from 65 to 89 years. About 63% of participants were female, and the rest were male. About 92% of participants were White, and about 7% were Black.
What Benefits Were Seen?
Study 1
In the five-week study, according to caregivers, participants who took Auvelity had less frequent agitation after five weeks than those who took a placebo. You can see the specific results in the table below.
| Auvelity (152 people) | Placebo (156 people) | |
|---|---|---|
| Average Baseline CMAI Score | 60.8 | 59.3 |
| Average Change From Baseline | -14.9 | -11.6 |
| Difference from Placebo | -3.3 | — |
Study 2
Continuing to take Auvelity seems to make a difference. In the six-month study, participants who continued taking Auvelity had a significantly longer time before their agitation symptoms returned than those who stopped taking it. This suggests that staying on Auvelity long term may be important to keep dementia-related agitation under control.
Keep in mind that your results may differ from what was seen in these studies.
How Long Does It Take for Auvelity to Work?
Auvelity seems to start working pretty quickly after you start taking it. In the five-week study, some benefits were seen as early as about one to two weeks after starting the medicine. Additional improvements were seen over the course of five weeks. Keep in mind that everyone responds in their own way to medicine. Some people may respond more quickly than others.
Is Auvelity Right for Me or My Loved One?
Auvelity may not be the right medicine for everyone who has dementia-related agitation from Alzheimer’s disease. Certain medicines, health conditions, or allergies may mean Auvelity is not the right medicine for you or your loved one. Before starting Auvelity, your health care provider will review your full health history. Some conditions or medicines may mean that Auvelity is not a good option for you.
Seizure risk
One possible side effect of Auvelity is seizures. The risk may be higher if you have any of these conditions:
- Seizure disorder
- Current or past diagnosis of bulimia or anorexia nervosa
Your risk of seizures may also be higher if you suddenly stop or have withdrawal from any of the following:
- Alcohol
- A benzodiazepine, such as clonazepam (Klonopin), diazepam (Valium and others), or lorazepam (Ativan and others), which is a medicine used for anxiety, muscle spasms, or seizures
- A barbiturate, such as butalbital, phenobarbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
- Any medicine for seizures, such as carbamazepine, lamotrigine, or phenytoin
Other side effect risks
Other possible side effects of Auvelity include increased blood pressure and serotonin syndrome, which can be serious or life-threatening. Taking Auvelity too close to a monoamine oxidase inhibitor (MAOI), a type of medicine sometimes used for depression or Parkinson’s disease, can raise this risk.
You should not take Auvelity if you have any of the seizure risk factors listed above. You should also avoid it if you are taking an MAOI or have taken one in the past 14 days. Do not start an MAOI until at least 14 days after your last dose of Auvelity. If you have questions about whether Auvelity is right for you or your loved one, talk to your health care provider.
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