From the Guidelines
If Ativan is ineffective for agitation in Parkinson's disease, quetiapine is a suitable alternative, starting with a dose of 25 mg orally, due to its lower risk of worsening motor symptoms compared to typical antipsychotics 1. When considering alternatives to Ativan for agitation in Parkinson's disease, it's crucial to prioritize medications that minimize the risk of exacerbating motor symptoms.
- Atypical antipsychotics are generally preferred over typical antipsychotics because they have a lower risk of causing extrapyramidal side effects (EPSEs), which can worsen Parkinson's symptoms.
- Quetiapine, an atypical antipsychotic, is a reasonable choice, with a suggested starting dose of 25 mg orally, which can be adjusted as needed, taking into account the patient's response and tolerance to the medication 1.
- Other atypical antipsychotics like olanzapine and risperidone can also be considered, but their use should be cautious, especially with olanzapine, due to the potential for metabolic effects and the risk of oversedation when combined with benzodiazepines 1.
- Non-pharmacological interventions should always be part of the management plan, focusing on creating a calm environment, addressing potential underlying causes of agitation such as pain or infection, and utilizing behavioral techniques to manage agitation.
- Regular monitoring of the patient's response to the medication, as well as potential side effects, is essential to ensure that the chosen treatment is effective while minimizing adverse effects on motor function and cognition.
From the Research
Alternatives to Ativan for Agitation in Parkinson's Disease
If Ativan (lorazepam) is ineffective for agitation in Parkinson's disease, several alternative treatments can be considered:
- Atypical antipsychotics, such as clozapine, quetiapine, olanzapine, risperidone, and ziprasidone, which have been shown to be effective in treating psychosis and agitation in Parkinson's disease patients 2, 3, 4, 5, 6
- Cholinesterase inhibitors, which have been reported to alleviate psychosis in Parkinson's disease 2
- Ondansetron, an antiemetic with antiserotonergic properties, which has been reported to relieve psychosis in Parkinson's disease, although its use is limited due to high cost 2
Atypical Antipsychotics
The choice of atypical antipsychotic depends on various factors, including the patient's medical history, the severity of symptoms, and the potential for side effects:
- Clozapine has been shown to be effective in treating psychosis and agitation in Parkinson's disease patients without worsening motor function, but it requires regular blood monitoring due to the risk of agranulocytosis 2, 4, 5, 6
- Quetiapine is generally well-tolerated and effective, but may cause sedation and orthostatic hypotension 2, 4, 6
- Olanzapine and risperidone may worsen motor function in some patients, although they can be effective in treating psychosis and agitation 2, 3, 4, 5
- Ziprasidone is a newer atypical antipsychotic that has been shown to be effective in treating agitation, but its use in Parkinson's disease is limited due to lack of studies 3
Other Considerations
When treating agitation in Parkinson's disease, it is essential to:
- Simplify and reduce anti-Parkinson's disease medications as much as tolerated to minimize side effects 4
- Monitor patients closely for potential side effects, such as worsening motor function, sedation, and orthostatic hypotension 2, 3, 4, 5, 6
- Consider non-pharmacological interventions, such as behavioral therapy and environmental modifications, to manage agitation and psychosis in Parkinson's disease patients 3