<jats:sec><jats:title>Background</jats:title><jats:p>The aim of this cross‐sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long‐term care facilities in East Asia and to explore factors associated with these patterns.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This study included elderly participants with cognitive impairments residing in long‐term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini‐Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti‐dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly‐pharmacy was identified as a common problem at all study sites.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings will be beneficial for health‐care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly‐pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence‐based practice.</jats:p></jats:sec>