From the Research
Olanzapine is not recommended for managing agitation in Parkinson's disease due to its high risk of worsening motor symptoms, and instead, alternatives such as quetiapine or pimavanserin should be considered. When Ativan (lorazepam) is not effective, several other options can be used to manage agitation in Parkinson's disease, though caution is needed as many antipsychotics can worsen motor symptoms.
- Quetiapine (Seroquel) is generally the preferred option, starting at 12.5-25mg at bedtime and gradually increasing if needed, with typical doses ranging from 25-200mg daily, as seen in a case study where quetiapine was well tolerated and resulted in behavioral improvement without worsening parkinsonism 1.
- Clozapine (Clozaril) is also effective at low doses (6.25-50mg daily) but requires regular blood monitoring due to the risk of agranulocytosis.
- Pimavanserin (Nuplazid), specifically approved for Parkinson's disease psychosis, can be used at 34mg once daily. Non-pharmacological approaches should be tried first, including maintaining routine, ensuring adequate sleep, and addressing underlying causes of agitation.
- The goal should be to use the lowest effective dose for the shortest duration possible, with regular reassessment of the need for continued treatment, as olanzapine has been shown to be ineffective in treating medication-induced psychosis in Parkinson's disease and can worsen motor symptoms 2, 3.