Dementia is a progressive neurodegenerative disorder characterized by cognitive decline, affecting an estimated 55 million people globally, with prevalence projected to rise substantially by 2050. Beyond cognitive impairment, behavioral and psychological symptoms of dementia (BPSD) pose significant challenges in clinical management, with aggression being among the most distressing manifestations. Aggressive behaviors—including verbal outbursts, physical attacks, resistance to care, and socially inappropriate actions—affect 20–30% of individuals with dementia, exacerbating caregiver burden, accelerating functional decline, increasing the likelihood of institutionalization, and inflating healthcare costs. The development of aggression in dementia is multifactorial, arising from neuropathological changes, unmet physical or emotional needs, environmental stressors, and communication barriers. Effective management strategies are essential to mitigate these impacts, with pharmacological interventions playing a central role in controlling aggressive behaviors and improving patient and caregiver outcomes. This review examines current drug-based approaches for aggression in dementia, highlighting evidence-based practices, safety considerations, and clinical challenges