Posted by ed_uk2010 on April 20, 2014, at 10:00:24
In reply to For my mom: Haldol for out of control delirium?, posted by zonked on April 20, 2014, at 9:18:47
Antipsychotics are generally not effective at getting rid of delusions which occur in the setting of dementia, but they can sometimes temporarily reduce agitation and aggression (as occur in dementia, delirium and psychosis associated with dementia). Sadly, dementia is always a progressive condition but psychiatric symptoms can fluctuate a great deal from day to day and week to week. In time, this delusion may disappear, but may be replaced by something else.
I think you handled the situation very well. If you can handle these problems without additional medication that's great but occasionally the PRNs will be appropriate. Your mum already takes a lot of benzos for someone with dementia. Benzos worsen cognitive function and memory, increase confusion and increase the risk of falls. If she's been taking regular benzos for many years, they may be very difficult to taper but I would be cautious not to use too many PRN doses unless it's absolutely unavoidable.
Haloperidol 0.5mg or risperidone 0.25mg-0.5mg may be tried if something is necessary to reduce agitation, but they probably won't get rid of the delusion. Haloperidol is more like to cause movement disorders, risperidone is more likely to cause a BP drop or dizziness. When used regularly in people with dementia, both drugs increase the risk of death, stroke and pneumonia. Risperidone is approved for use for a maximum of 6 weeks in dementia pts in the UK; it is not approved for this use in the US. The initial dose is 0.25mg up to twice a day, increasing to 0.5mg twice a day if necessary. The drug should be tapered off as soon as possible. Repeated courses can be used for exacerbations of symptoms. For haloperidol, the usual dose is 0.5mg up to twice a day (as necessary). In some cases, distraction techniques may reduce agitation and improvement in lighting/surroundings may reduce confusion. Of course, it's often not enough...
Overall, either risperidone or haloperidol could be used as a PRN, but the doses used should be kept very low, and treatment should be short-term. Unfortunately, it's common for the meds not to help, in which case they should be stopped. I do think either med is more likely to be effective than lorazepam however, because your mum is already taking benzodiazepines. Mutiple benzodiazepines are not generally recommended. Neither antipsychotic can be used if the diagnosis is Lewy Body dementia, but can be used very cautiously in Alzheimer's disease if the benefits seem to outweigh the risks.
It must be so hard for you, and your mum. Hope you find something that helps.
poster:ed_uk2010
thread:1064516
URL: http://www.dr-bob.org/babble/20140419/msgs/1064518.html