Is starting Meclizine 12.5 mg TID PRN reasonable for managing dizziness in a patient with schizophrenia, neurocognitive disorder, senile dementia, and recent rib fractures, who is taking olanzapine and Effexor?

From the Guidelines

Starting Meclizine 12.5 mg TID PRN is not the most appropriate approach for managing dizziness in this patient with schizophrenia, neurocognitive disorder, senile dementia, and recent rib fractures who is taking olanzapine and Effexor. Given the patient's complex medical history and current medications, it is crucial to consider the potential risks and interactions associated with meclizine. The patient is already taking olanzapine, which can cause drowsiness, orthostatic hypotension, and metabolic effects 1. Adding meclizine, an antihistamine with potential anticholinergic effects, may exacerbate cognitive function decline and increase the risk of sedation, urinary retention, dry mouth, and constipation.

Instead of meclizine, it would be more reasonable to investigate the underlying cause of dizziness, which could be related to orthostatic hypotension from current medications, particularly Effexor and olanzapine 1. Measuring orthostatic vital signs and potentially adjusting current medications might be necessary before adding any new medications to the regimen. Some key points to consider in managing this patient's dizziness include:

• Monitoring for excessive drowsiness, confusion, urinary retention, dry mouth, and constipation
• Investigating the underlying cause of dizziness, including orthostatic hypotension
• Potentially adjusting current medications, such as Effexor and olanzapine, to minimize their contribution to dizziness
• Considering alternative treatments for dizziness that have a more favorable side effect profile in patients with neurocognitive disorders.

From the Research

Patient Profile

• 75-year-old patient with a history of schizophrenia and neurocognitive disorder
• Currently taking olanzapine and Effexor for psychiatric management
• Recent rib fractures and experiencing dizziness
• Senile dementia with sun-downing and early morning confusion

Medication Management

• Olanzapine is being used to manage psychosis, but its effectiveness in dementia-related psychosis is debated 2
• Studies suggest that olanzapine may have non-significant small numerical improvements in psychosis symptoms, but is associated with greater odds of mortality, cerebrovascular events, and discontinuations due to adverse events 2
• The patient's dementia and neurocognitive disorder may be contributing to their confusion and disorientation, and the use of antipsychotics like olanzapine may need to be carefully considered 3, 4

Dizziness Management

• Meclizine 12.5 mg TID PRN has been prescribed to manage dizziness
• However, there is limited evidence to suggest that meclizine is effective in managing dizziness in patients with dementia or neurocognitive disorders
• The patient's dizziness may be related to their recent rib fractures, medication side effects, or underlying medical conditions, and a thorough evaluation is necessary to determine the cause of their dizziness

Considerations

• The patient's complex medical and psychiatric history requires careful consideration when managing their medications and symptoms
• The use of antipsychotics like olanzapine in patients with dementia is associated with increased risk of adverse events, and alternative treatments or non-pharmacological interventions may be necessary 2, 3
• Regular monitoring of the patient's symptoms, medication side effects, and overall health is crucial to ensure optimal management of their condition 5, 6