Start Low and Go Slow: Dosing of Antipsychotic Medications in Elderly Patients With Dementia

Jerry H. Gurwitz, MD
Arch Intern Med. 1995;155(18):2017-2018. doi:10.1001/archinte.1995.00430180135018.
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I read with interest the review article by Yeager et al1 on the management of the behavioral manifestations of dementia. The article included a treatment algorithm suggesting a management strategy for the demented patient with aberrant behavior. The algorithm appropriately emphasized nonpharmacologic approaches as the optimal initial management strategy for these patients. For the patient who is unresponsive to nonpharmacologic measures, the algorithm recommended the initiation of a trial of antipsychotic therapy for 8 weeks. The suggested regimens include haloperidol, 2.5 mg at bedtime, or thioridazine, 25 mg at bedtime, with titration of these doses according to the patient's response to therapy. Buried in the legend of the figure describing the treatment algorithm was a recommendation that a lower starting dose is recommended in the elderly. However, no dosing recommendations were given and the less-than-careful reader could easily miss this important warning. Since the elderly constitute the vast majority


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