Dementia: Medications for behavioural and psychological symptoms
Table 10.3: Medications for treatment of behavioural and psychological symptoms of dementia
risperidone | olanza- pine | quetia- pine | citalo- pram | trazo- done |
---|---|---|---|---|
Indications | ||||
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 |
Side-effects | ||||
risperidone
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
Rarely may cause priapism |
Monitoring | ||||
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 |