Pharmacologic Management Table
Indication Commonly Used Medications Dosage Forms Initial Dose
(range)		 Side Effects Monitoring
AGITATION

Atypical Antipsychotics
Olanzapine
(Zyprexaâ)		 5, 7.5,10mg tabs 5mg/d
(5-20mg/d)+		 Peripheral edema, headache, orthostatic hypotension, somnolence, seizures, dystonic reactions, constipation, rash, dry mouth Orthostatic BP, extrapyramidal effects, targeted behavioral symptoms
Quetiapine
(Seroquelâ)		 25, 100, 200mg tabs 25mg bid
(50-200mg/d)*+

Headache, somnolence, dizziness, ortho hypotension, tachycardia, bradycardia, irregular pulse, A-V block, prolonged

P-T interval, constipation, dry mouth, cataracts

 Drowsiness, dizziness, headache, eye exams for cataracts, targeted behavior symptoms
Risperidone
(Risperdalâ)		 1mg/ml oral soln; 0.25,0.5, 1,2,3,4mg tablets 0.25-0.5mg qd-bid
(0.25-1mg/d)*+		 Ortho hypotension, arrhythmias, sedation, anxiety, dry mouth, constipation, sexual dysfx, leukopenia Orthostatic BP, extrapyramidal effects, targeted behavior symptoms
Ziprasidone (Geodon) 20, 40, 60, 80 capsule
IM 20mg/ml
IM long-acting 25, 37.5, 50mg/2mL		 20-80 (1-2) May increase QT
Very limited geriatric literature		 QT interval
Anticonvulsants

Divalproex sodium (Depakoteâ)

Sodium Valproate (Depakene syrupâ)

Valproic acid (Depakeneâ)

Divalproex: 125mg sprinkle capsule, 125, 250, 500mg delayed release tablet
Sod. valproate: 250mg/5ml syrup;
Valproic acid 250mg capsule

 10-15mg/kg/d divided in 1-3 doses; most common is bid+ Peripheral edema, drowsiness, ataxia, alopecia, nausea,vomit-ing, diarrhea, anorexia, abdominal cramps, thrombocyto-penia, asterixis, diplopia, “spots before the eyes” LFT and CBC for first 6 months; therapeutic blood levels?, side effects, targeted behavior symptoms
Carbamazapine (Tegretolâ)

100mg/5ml oral suspension;
200mg tab;
100mg chewable;
100, 200, 400mg extended release tablet

200mg bid
(800-1200mg/d in divided doses)

 

 Sedation, dizziness, Stevens-Johnson syndrome, leukopenia, neutropenia, aplastic anemia, SIADH, nausea, GI distress, diplopia, nystagmus, dyspnea CBC, side effects, targeted behavior symptoms, serum concentrations??
Benzodiazepine

Lorazepam (Ativanâ)

Note:  especially helpful for acute episodes and ideally should be used short-term

2, 4mg/ml injection;
2mg/ml oral solution;
0.5,1,2mg tablet

 0.5-1.0mg/d in divided doses (1-3mg/d in divided doses) Drowsiness, confusion, dizziness, hypotension, ataxia, amnesia, slurred speech, paradoxical excitement or rage, dry mouth, blurred vision, diplopia, nystagmus, decrease in resp rate, dependence Respir, Cardiovasc, and mental status, targeted behavior symptoms; dose should be tapered down if want to d/c after prolonged use
Resotoril
Temazepam

Note: Good for use with sleep disorder

 Capsule 7.5, 15, 30 7.5 - 15 Daytime drowsiness with repeated dosing Gait and Balance
Anti-depressants
Trazodone (Desyrelâ) 50,100,150, 300mg tablet

25-50mg h.s.
(75-150mg qd-bid)

 Ortho hypotension, drowsiness, dizziness, confusion, dry mouth, constipation, nausea/vomit, weakness Orthostatic BP, pulse, targeted behavior symptoms

Buspirone (BuSparâ)

Note:  most helpful for long-term anxiety control)		 5, 10mg tablet

5mg bid (10-30mg/d in divided doses-bid)+

Note:  takes 1-2 wks. to see initial effect;  3-4 wks for maximum effect

Sedation, disorientation, dizziness, headache, ataxia, rash, urticaria, nausea/vomiting, diarrhea, leukopenia Mental status, targeted anxiety symptoms
Paroxitene
Paxil		 Tablet 10, 20, 30, 50
Ext Rel 12.5, 25, 37.5
Solution 10mg/5mL		 10-40 mg/day Increased risk of withdrawal symptoms (dizziness)
Hepatic metabolism/Check drug-drug		 Increase by no more than 12.5mg/d once per week
Liver
High Potency Antipsychotic-Alternative dosing IM & elixir and cost indications $
Haloperidol
(Haldol)		 Table 0.5, 1, 2, 5, 10
Solution conc 2mg/mL
IM		 0.5-2 (1-3)
depot 100-20 mg IM q week		 Increased EPS and tardive dyskinesia in elderly Acute use only
Keep dose low
SUN-DOWNING Atypical Antipsychotics   Administer mid-afternoon or early evening    

Trazodone

   Administer mid-afternoon or early evening    
AGGRESSION Atypical Antipsychotics        

Buspirone
(Buspar)

        

Anticonvulsant

        
SLEEP DISTURBANCE Trazodone   Administer 25-100mg at bedtime    

Lorazepam

   Short-term use only (i.e. <2 wks)    
HALLUCINATIONS & DELUSIONS Atypical Antipsychotics        

Olanzapine
(Zyprexaâ)

 5, 10, 15 & 
20 mg disintegrating tablets

5mg/d
(5-20mg/d)+

 Peripheral edema, headache, orthostatic hypotension, somnolence, seizures, dystonic reactions, constipation, rash, dry mouth Orthostatic BP, extrapyramidal effects, targeted behavioral symptoms

Quetiapine
(Seroquelâ)

 

 25, 100, 200 & 300 mg tabs

25mg bid
(50-200mg/d)*+

 

Headache, somnolence, dizziness, ortho hypotension, tachycardia, bradycardia, irregular pulse, A-V block, prolonged

P-T interval, constipation, dry mouth, cataracts

 Drowsiness, dizziness, headache, eye exams for cataracts, targeted behavior symptoms

Risperidone
(Risperdalâ)

 

 1mg/ml oral soln; 0.25,0.5, 1,2,3,4mg tablets

0.25-0.5mg qd-bid
(0.25-1mg/d)*+

 Ortho hypotension, arrhythmias, sedation, anxiety, dry mouth, constipation, sexual dysfx, leukopenia Orthostatic BP, extrapyramidal effects, targeted behavior symptoms
DEPRESSION Selective Serotonin Reuptake Inhibitors        
Citalopram (Celexaâ) 20, 40mg tablets

20mg qd
(20-40mg qd+

 Somnolence, insomnia, anxiety, agitation, SIADH, decreased libido, nausea, dry mouth, diarrhea, dyspepsia, vomiting, anorexia, tremor Side effects; targeted depressive symptoms
Fluoxetine (Prozacâ) 10,20mg capsule; 20mg/5ml liquid; 
90 mg once a week tablet

10mg qd (morning)
(10-20mg qd)+

Same as above; and headache

Note:  longest half-life of all SSRIs		 Same as above
Paroxetine (Paxilâ)

10,20,30,40mg tablets;
10mg/5ml oral suspension

10mg qd (morning preferred unless sedation)
(20-30mg qd)

 Same as above; and anemia, leukopenia, paresthesia, eye and ear pain, asthma Same as above
Sertraline (Zoloftâ) 25, 50, 100mg tablet

25mg qd (morning preferred)
(50-100mg qd)

 Same as above Same as above
Atypical Antidepressants        
Buproprion (Wellbutrinâ)

75,100mg tablet;
100,150mg sustained release tablet

50-100mg qd (75-100mg 
bid) *+

Note:  single and multiple dosing schedule can accumulate in elderly

 Agitation, insomnia, headache psychosis, confusion, akathisia, nausea/vomiting, seizures, impotence, tremors, blurred vision Side effects; targeted depressive symptoms
Mirtazapine (Remeronâ) 15,30mg tablet

7.5mg h.s. (15-30mg/d)*+

 Hypotension, palpitations, drowsiness, headache, dizziness, agitation, increased appetite, constipation bitter taste, decreased libido, increased LFTs, tremor,blurred vision, dyspnea Same as above
Nefazodone (Serzoneâ) 100, 200, 250mg tablet

50mg bid (100-200mg bid)

Ortho hypotension, bradycardia, headache, drowsiness, insomnia, dry mouth, nausea/vomiting, constipation, diarrhea, tremor, blurred vision Same as above
Venlafaxine (Effexorâ) 25,37.5, 50,75, 100mg tablet; 37.5, 75,150mg extended release tablet 25-50mg bid or 37.5 SR qd (37.5-75mg SR qd)*+ Increased blood pressure (patients with history of HTN), tachycardia, headache, somnolence, dizziness, insomnia, anxiety, nausea, vomiting, diarrhea, constipation, impotence in men, tremors, blurred vision, diaphoresis Same as above

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