From the Guidelines
Discontinuing Abilify (Aripiprazole) and initiating a low-dose atypical antipsychotic, such as Quetiapine (Seroquel), is recommended to manage the patient's agitation and cognitive impairments, while continuing Sertraline (Zoloft) for their major depressive disorder. The patient's symptoms of significant cognitive impairments, restlessness, and agitation, with a history of major depressive disorder and unspecified dementia, suggest that the current medication regimen may not be adequately managing their dementia-related behavioral symptoms, and may be contributing to the agitation 1. According to the American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia, antipsychotic medications can be appropriate in individuals with dangerous agitation or psychosis, but their use should be carefully considered due to the risk of adverse effects, including mortality 1. The guideline suggests that atypical antipsychotics, such as Quetiapine, may be more effective for managing agitation and anxiety in patients with dementia, with a lower risk of extrapyramidal side effects compared to typical antipsychotics or other atypical antipsychotics like Aripiprazole 2. Key considerations for the use of Quetiapine in this patient include:
- Starting with a low dose, such as 25mg at bedtime, to minimize sedation and orthostatic hypotension
- Gradually increasing the dose, if necessary, to achieve optimal symptom management
- Implementing non-pharmacological interventions, such as maintaining a consistent daily routine, reducing environmental stimuli, and encouraging participation in structured activities during the day to help reduce agitation
- Close monitoring for sedation, orthostatic hypotension, and worsening cognitive symptoms, with follow-up evaluation in two weeks to assess response to the medication change 2. It is essential to weigh the potential benefits and harms of antipsychotic medication in this patient, considering their individual circumstances and clinical presentation, and to involve the patient's surrogate decision maker in the decision-making process, if relevant 1.
From the FDA Drug Label
The FDA drug label does not answer the question.