Agitation and Aggression

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1. Pharmacotherapy: The following agents have significant efficacy in reducing agitation and aggression in dementia.

a. Buspirone (BuSpar) beginning at 5 mg bid with a final dose of 3050 mg/day in bid or tid dosing. Buspirone has few side effects and no significant drug interactions. Several weeks are required to achieve full benefit.

b. Trazodone (Desyrel) beginning at 25-50 mg qhs with an average dose of 50-200 mg/day.

c. Risperidone (Risperdal) beginning at 0.25-0.5 mg qhs with an average dose of 0.5-2 mg day is especially effective for agitation associated with psychotic symptoms such as paranoia.

d. Olanzapine (Zyprexa) beginning at 2.5 mg qhs with an average dose of 2.5-7.5 mg qhs with an average dose of 2.5-7.5 mg qhs also reduces agitation in dementia.

e. Haloperidol (Haldol) may be used if risperidone or olanzapine are ineffective. Dose range is 0.5-5 mg/day given qhs or bid.

f. Divalproex (Depakote) at a dosage of 10 mg/kg/day (250-1250

mg/day bid) is well tolerated by many demented patients with good efficacy. Serum levels should be maintained between 25-75 mg/mL.

g. Lorazepam (Ativan), 0.5-1.0 mg q 4 hours prn, can provide rapid relief, but it is not recommended for long-term use because of ataxia, further memory impairment, and potential for disinhibition and physical dependence.

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