From the Guidelines
For a 92-year-old experiencing lip smacking and sedation from risperidone, switching to quetiapine is a viable option, given its lower risk of extrapyramidal symptoms and sedating effects that can be beneficial at night, as noted in the guidelines for managing Alzheimer's disease 1. When considering alternatives to risperidone, it's crucial to prioritize medications with a lower risk of tardive dyskinesia and extrapyramidal symptoms, especially in elderly patients.
- Quetiapine can be initiated at a low dose of 12.5-25mg at bedtime, with gradual increases as needed, taking advantage of its sedating effects to help manage nighttime agitation.
- The switch from risperidone to quetiapine should be done through a gradual cross-taper, slowly decreasing the risperidone dose while introducing quetiapine over 1-2 weeks, to minimize the risk of psychotic symptom recurrence or new side effects.
- Close monitoring during this transition period is essential to promptly address any emerging issues. The choice of quetiapine is supported by its pharmacological profile, which includes a different receptor binding mechanism compared to risperidone, potentially reducing the risk of movement disorders while maintaining antipsychotic efficacy, as discussed in the context of managing behavior and mood disorders in Alzheimer's disease patients 1.
From the Research
Alternative Antipsychotics
To avoid lip smacking and sedation caused by risperidone in a 92-year-old patient, alternative antipsychotics can be considered. The following options may be suitable:
- Aripiprazole: This antipsychotic has been shown to have a lower risk of extrapyramidal side effects compared to risperidone 2, 3.
- Quetiapine: Quetiapine has been found to have a lower risk of extrapyramidal side effects and sedation compared to risperidone 2, 4, 5.
- Olanzapine: Olanzapine has been shown to be effective in treating psychosis with a lower risk of extrapyramidal side effects compared to haloperidol 3, 5.
- Ziprasidone: Ziprasidone has been found to have a lower risk of extrapyramidal side effects and sedation compared to risperidone 2, 4.
Considerations
When switching to an alternative antipsychotic, the following considerations should be taken into account:
- Efficacy: The new antipsychotic should be effective in treating the patient's symptoms.
- Tolerability: The patient's tolerance to the new antipsychotic should be monitored, and adjustments made as needed.
- Side effects: The risk of side effects, such as extrapyramidal symptoms, sedation, and weight gain, should be considered when selecting an alternative antipsychotic.
- Dosage: The dosage of the new antipsychotic should be adjusted according to the patient's response and tolerance.
Evidence
The evidence suggests that aripiprazole, quetiapine, olanzapine, and ziprasidone may be suitable alternatives to risperidone in terms of efficacy and tolerability 2, 6, 3, 4, 5. However, the patient's individual response and medical history should be taken into account when making a decision.