In many unreinforced masonry (URM) buildings reinforced concrete (RC) slabs or ring beams maintain the integrity of the building when subjected to seismic loading and redistribute forces between different URM piers. In addition, RC slabs and ring beams contribute to the global stiffness and overturning capacity of the building by acting as horizontal coupling elements between URM piers. This paper reviews current design approaches concerning the consideration of the contribution of RC slabs and ring beams to the global overturning capacity of buildings with URM piers. Numerical simulations of composite spandrels consisting of RC beam and URM spandrel are performed and the results are compared with experimental evidence from own full-scale tests on composite spandrels. Finally, different wall configurations of URM buildings with RC slabs are analysed and conclusions concerning the design and analysis of such buildings drawn.