There is a death of literature on the effects of neuroleptics in older schizophrenia patients. In this article, we review the available literature and present findings from our own studies. Neuroleptics are effective in the treatment of late-life schizophrenia, although older patients generally need lower dosages than younger subjects. Neuroleptics, however, carry a relatively high risk of side effects such as tardive dyskinesia (TD) in middle-aged and elderly patients. By the end of 1 year of a prospective longitudinal study of neuroleptic treatment, we found a 26 percent cumulative incidence of TD among schizophrenia patients over age 45. If neuroleptics are withdrawn, there is a significant risk of a schizophrenic relapse; however, that risk is no greater in older patients than in younger ones. We offer clinical recommendations for the use of neuroleptics in the treatment of late-life schizophrenia.