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Antipsychotic Medications for the Elderly Research Paper

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Updated: Dec 2nd, 2020

First and Second Generation Antipsychotics

  • The use of antipsychotics of the first and second generations in adults with psychiatric issues is highly discouraged due to multiple adverse effects that these medications have on the target demographic;
  • The undesirable medications include: “amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, ziprasidone, CPZ, haloperidol, loxapine, and perphenazine” (Solmi et al., 2017).

Benzodiazepines

  • Benzodiazepines produce a mostly positive effect on older adult patients with psychiatric issues, yet dosage should be verified carefully due to the threat of patients developing a dependency on the specified type of medications;
  • Slow tapering protocols are required for keeping track of the changes in dosage and patients’ well-being;
  • In cases of insomnia and anxiety, Benzodiazepines should not be used as medication options (Markota, Rummans, Bostwick, & Lapid, 2016). Benzodiazepines are typically recommended for elderly patients since they do not accumulate in the blood (Ait-Daoud, Hamby, Sharma, & Blevins, 2018);
  • Dosage:
    • Alprazolam: 2 mg/day
    • Bromazepam: 18 mg/day
    • Clonazepam: 0.75-1 mg/day
    • Diazepam: 3 mg/day (Kacirova, Grundmann, Silhan, & Brozmanova, 2016)
    • Estazolam: 1 mg/day
    • Lorazepam: 0.3 mg/day
    • Midazolam: 3.75-4 mg/day (Su et al., 2016)
    • Nitrazepam: 5 mg/day (Ait-Daoud et al., 2018).

Lithium

  • Using Lithium in elderly patients is a common practice in psychiatry for addressing manic episodes (De Fazio et al., 2017);
  • Specifically, the medication is used for addressing the needs of elderly patients with bipolar disorder (De Fazio et al., 2017);
  • The advisable dosage for Lithium in aging patients is 300-600 mg/day;
  • Due to the body composition of older patients, particularly, the percentage of water in their bodies, Lithium distribution in the target population may vary (De Fazio et al., 2017).

Antiepileptics

  • Due to the possibility of adverse changes in the body functions of elderly patients, the application of antiepileptics requires particular care;
  • Age-related changes in patients’ bodies define the effects that anticonvulsants produce (Douglas-Hall, Dzahini, Gaughran, Bile, & Taylor, ‎2017);
  • In addition, medical comorbidities have to be examined closely prior to selecting an antiepileptic;
  • Dosage:
    • Depakote: 500-1,000 mg/day.
    • Lamicta: 25-50 mg/day (Douglas-Hall et al., ‎2017).

References

Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawal. Journal of Addiction Medicine, 12(1), 4-10. Web.

De Fazio, P., Gaetano, R., Caroleo, M., Pavia, M., De Sarro, G., Fagiolini, A., & Segura-Garcia, C. (2017). Lithium in late-life mania: A systematic review. Neuropsychiatric Disease and Treatment, 13, 755-766. Web.

Douglas-Hall, P., Dzahini, O., Gaughran, F., Bile, A., & Taylor, D. (2017). Variation in dose and plasma level of lamotrigine in patients discharged from a mental health trust. Therapeutic Advances in Psychopharmacology, 7(1), 17-24. Web.

Kacirova, I., Grundmann, M., Silhan, P., & Brozmanova, H. (2016). A case report of clonazepam dependence: Utilization of therapeutic drug monitoring during withdrawal period. Medicine, 95(9), 1-5. Web.

Markota, M., Rummans, T. A., Bostwick, J. M., & Lapid, M. I. (2016). Benzodiazepine use in older adults: Dangers, management, and alternative therapies. Mayo Clinic Proceedings, 91(11), 1632-1639. Web.

Solmi, M., Murru, A., Pacchiarotti, I., Undurraga, J., Veronese, N., Fornaro, M.,… & Correll, C. U. (2017). Safety, tolerability, and risks associated with first-and second-generation antipsychotics: A state-of-the-art clinical review. Therapeutics and Clinical Risk Management, 13, 757-777. Web.

Su, X., Meng, Z. T., Wu, X. H., Cui, F., Li, H. L., Wang, D. X.,… & Ma, D. (2016). Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: A randomised, double-blind, placebo-controlled trial. The Lancet, 388(10054), 1893-1902. Web.

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