Atypicals Address Behavioral Problems in Alzheimer's.SAN DIEGO -- The serotonin-dopamine antagonist class of antipsychotics--also known as atypical antipsychotics--are far superior to dopamine receptor antagonists Dopamine receptor antagonists (DAs) The older class of antipsychotic medications, also called neuroleptics. These primarily block the site on nerve cells that normally receive the brain chemical dopamine. Mentioned in: Schizophrenia for treating behavioral disturbances in patients with Alzheimer's disease, Dr. Daniel Sewell said at a meeting on Alzheimer's disease sponsored by the University of California, San Diego UCSD is consistently ranked among the top ten public universities for undergraduate education in the United States by U.S. News & World Report.[3] It is a Public Ivy. [1] For graduate studies, most of UCSD's Ph.D. . "They seem to be much better tolerated than the older drugs" like chlorpromazine chlorpromazine (klōrpräm`əzēn'), one of a group of tranquilizing drugs called phenothiazines that are useful in halting psychotic episodes. and haloperidol haloperidol /hal·o·peri·dol/ (hal?o-per´i-dol) an antipsychotic agent of the butyrophenone group with antiemetic, hypotensive, and hypothermic actions; used especially in the management of psychoses and to control vocal utterances and , said Dr. Sewell, medical director of the senior behavioral health inpatient unit at the university "These medicines are much less likely to cause extrapyramidal extrapyramidal /ex·tra·py·ram·i·dal/ (-pi-ram´i-d'l) outside the pyramidal tracts; see under system. ex·tra·py·ram·i·dal adj. side effects. That's important in our patient population, because we know that extrapyramidal side effects are associated with clumsiness and falling." The downside of atypical antipsychotics is that not all of them are covered by managed care formularies. He added that there is no "perfect" atypical antipsychotic. "Each one has its unique strengths and weaknesses. Because most of these medicines are so new, our experience using them in the elderly is somewhat limited. But from what we see so far, they are safe and effective," he said, commenting on each of the available agents: * Risperidone (Risperdal). This has the most potent antidopaminergic effect of all the atypicals. Possible side effects include blurred vision, postural hypotension, and extrapyramidal symptoms. The recommended dose is 0.25-0.5 mg/day, up to 3 mg/day. * Olanzapine (Zyprexa). Possible side effects include increased weight gain and postural hypotension. The recommended dosage is 2.5-5 mg/day, up to 15 mg/day. * Clozapine clozapine /clo·za·pine/ (klo´zah-pen) a sedative and antipsychotic agent; used in the treatment of schizophrenia. clo·za·pine n. (Clozaril). This agent is especially useful for patients with symptoms of Parkinson's disease, but it has the potential to cause agranulocytosis agranulocytosis (əgrăn'yəlōsītō`sis), disease in which the production of granulated white blood cells by the bone marrow is impaired. . The recommended dosage is 6.25-12.5 mg/day, up to 300 mg/day. * Quetiapine (Seroquel). Possible side effects include drowsiness, dizziness, and constipation. The recommended dosage is 25-50 mg/day, up to 300 mg/day. * Ziprasidone (Geodon). This agent, the newest in its class, is contraindicated in patients with Q-T interval prolongation. "So before putting someone on this medicine, it is important to do an EKG and establish his or her Q-T interval," he said. Other possible side effects include drowsiness and rash. The recommended dosage is 20 mg/day with food, up to 40 mg/day. |
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