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Dementia: Medications for behavioural and psychological symptoms

Table 10.3: Medications for treatment of behavioural and psychological symptoms of dementia




olanza- pine

quetia- pine

citalo- pram

trazo- done


Atypical antipsy- chotics are best supported treat- ment for BPSD



Similar to an- tipsychotics Second-line treatment

for severe aggression or agitation (start with atypical)

Sleep distur- bance asso- ciated with dementia Treatment of behaviours

in fronto- temporal dementia

Initial dose

0.25 od or bid

2.5 mg po qhs

12.5 – 25 mg po bid or qhs

10 mg

25 mg po qhs

Titration schedule

Increase by

0.25 – 0.5 mg every 2 – 4 weeks

Increase by

2.5 mg every

2 – 4 weeks

Increase by

25 – 50 mg every 2 – 4 weeks

10 mg every

2 – 4 weeks

25 mg every

2 – 4 weeks

Maximum  dose

2 mg

10 mg

200 mg

40 mg

150 mg






All antipsychotics can cause: sedation,

falls, orthostatic hypotension, weight gain, impaired glucose tolerance, dyslipidemia

olanza- pine

quetia- pine

citalo- pram


All SSRIs can cause: Headache Anorexia Nausea Diarrhea Sleep problems (HANDS)


Increased risk of bleeding. Monitor for hyponatremia

trazo- done


Highly sedating


Orthostatic hypotension



may cause priapism


Fasting lipids and glucose, gait, extrapyramdidal symptoms



Serum sodium, hemoglobin


Special notes

Most likely

to cause EPS, especially at higher doses. Increased risk

of mortality and possibly stroke with all atypical antipsychotics*

Most likely to cause weight

gain and metabolic side-effects. Less EPS than ris- peridone. More sedat- ing than risperidone

Very sedating Least likely to cause EPS, should be used first in Parkin- son's and Lewy body dementia

Emerging evidence suggests it may be as effective as antipsycho- tics. Also effective

in treating behaviours associated with fron- totemporal dementia

Usually in treatment of sleep

disturbance associ-

ated with dementia