Antipsychotics for agitation, aggression or psychosis of dementia
If nonpharmacological management does not alleviate agitation, aggression or psychosis of dementia and symptoms are distressing for the patient, or the patient is considered a threat to themselves or others, consider the benefit–harm profile of antipsychotic use for the patient; see hereMa 20141.
If immediate intervention is not required, engage in shared decision making with the patient or their substitute decision-maker. Discuss:
- the purpose, limitations and risks associated with antipsychotic use and the importance of combining antipsychotic use with nonpharmacological interventions
- adverse effects associated with antipsychotic use and how these effects are monitored, and potentially prevented or addressed.
If an antipsychotic is considered necessary for agitation, aggression or psychosis of dementia that is not associated with Lewy bodies or Parkinson disease, useReus 2016:
1 risperidone 0.25 mg orally, twice daily. If needed, increase the dose by 0.25 mg twice daily every 2 or more days2. Maximum of 2 mg daily in 1 or 2 doses. Use the lowest effective dose for the shortest period of time; see Follow-up and duration of antipsychotic therapy for agitation, aggression or psychosis of dementia agitation, aggression or psychosis in dementia risperidone risperidone risperidone
OR
2 olanzapine 2.5 mg orally, daily. If needed, increase the dose by 2.5 mg daily every 7 or more days2. Maximum of 10 mg daily in 1 or 2 doses. Use the lowest effective dose for the shortest period of time; see Follow-up and duration of antipsychotic therapy for agitation, aggression or psychosis of dementia. agitation, aggression or psychosis in dementia olanzapine olanzapine olanzapine
If aripiprazole is considered, seek expert advice on dosage.
For advice on neuropsychiatric symptoms associated with Parkinson disease, see here.
If an antipsychotic is considered necessary for agitation, aggression or psychosis of dementia associated with Lewy bodies (ie rivastigmine or donepezil is inadequate), use:
quetiapine immediate-release 12.5 to 25 mg orally, once or twice daily. If needed, increase the dose by 12.5 to 25 mg daily every 2 or more days2. Maximum of 75 mg twice a day. Use the lowest effective dose for the shortest period of time; see Follow-up and duration of antipsychotic therapy for agitation, aggression or psychosis of dementia. agitation, aggression or psychosis in dementia quetiapine quetiapine quetiapine