The atypical antipsychotic drugs are a group of related medicines that tend to have fewer side effects than the older, conventional antipsychotics. Although none of them have Food and Drug Administration approval for use in dementia patients, they are often used to treat behavior problems in those with Alzheimer's disease. However, this use must be weighed against the increased risk of death highlighted by an FDA black box warning.
Olanzapine
According to an article on the Cochrane Reviews website, olanzapine, or Zyprexa, lessens aggression in Alzheimer's patients, but with a cost of increased risk of strokes and other life-threatening side effects. If used, low doses of 1.25 to 5 milligrams per day should be employed. It is available in tablets as well as an orally disintegrating form. The injectable suspension is not commonly used in this population. This drug commonly causes sedation, and usually leads to weight gain. Elderly patients may experience a lowered blood pressure or seizures, according to "American Family Physician." Olanzapine is also known to elevate blood glucose and cholesterol levels and Drugs.com recommends monitoring these.
Quetiapine
This drug, which is sold under the brand name Seroquel, may be used in Alzheimer's patients to treat aggression or agitation. However, it also carries the FDA warning regarding increased death rates in this population. Quetiapine is available in regular release and extended release tablets. "American Family Physician" recommends starting at 12.5 milligrams at bedtime and increasing the dose as necessary. Common side effects include sleepiness, headache, dry mouth and weight gain. It also has the potential to worsen cholesterol and blood sugar levels. Alcohol and other sedatives should be avoided in those taking quetiapine. Carbamazepine and valproic acid, two antiseizure medications, may interact poorly with quetiapine.
Risperidone
Risperidone, sold as the brand name Risperdal, has been shown to improve aggression and psychosis in people with Alzheimer's disease, according to the Cochrane Reviews website. However, it too carries the risk of stroke and death. This drug is available in tablets, oral suspension, powder for suspension and disintegrating tablets. The lowest effective dose should be employed and starting doses of 0.25 milligrams a day are recommended by "American Family Physician." Extrapyramidal symptoms of restlessness and abnormal movements are seen commonly with this drug, as are fatigue, increased appetite, urinary incontinence and fever, according to Drugs.com. Blood sugar and blood pressure should be monitored during therapy with risperidone. Doses of either drug may need to be adjusted when administered concurrently with carbamazepine, phenytoin, fluoxetine or paroxetine.
References
- "American Family Physician"; Use of Atypical Antipsychotics Drugs in Patients With Dementia; Charles D. Motsinger, CAPT, USAF, MC, Gregory A. Perron, CAPT, USAF, MC, and Timothy J. Lacy, LTCOL, USAF, MC; June 2003
- Drugs.com: Olanzapine
- Cochrane Reviews: Atypical Antipsychotics for Aggression and Psychosis Associated with Dementia
- National Institute of Mental Health: Mental Health Medications
- Drugs.com: Quetiapine
