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

Bryan F. Yeager, PharmD
Arch Intern Med. 1995;155(18):2018. doi:10.1001/archinte.1995.00430180135019.
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In reply  Gurwitz's concerns regarding an appropriate starting dose for antipsychotic therapy in elderly patients with behavioral symptoms of dementia is well founded. Elderly individuals (>65 years of age) have increased sensitivity to neuroleptic adverse effects, and their treatment should begin with the smallest effective dose. In fact, research suggests that smaller doses of antipsychotic agents may be as efficacious as larger ones.1 Recommended initial doses of haloperidol and thioridazine within the treatment algorithm are based on dosages used in clinical trials evaluating these agents in demented patients with aberrant behavior.2,3 The difference in design between the two studies does not allow direct comparison of equivalent doses of antipsychotic agents; however, 2 mg of haloperidol is therapeutically equivalent to 100 mg of thioridazine.4 Although the algorithm indicates that a lower starting dose is recommended in the elderly, perhaps dosing recommendations for this patient population would clarify treatment


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