From the Guidelines
For an agitated patient with Parkinson's disease during summer, quetiapine is generally the safest antipsychotic option, starting at a low dose of 12.5-25mg and titrating as needed, according to the most recent and highest quality study available 1.
Key Considerations
- Quetiapine has a lower risk of worsening Parkinson's symptoms compared to typical antipsychotics or other atypicals like risperidone or olanzapine, which can block dopamine receptors and worsen motor symptoms.
- Summer conditions are particularly relevant as heat can exacerbate Parkinson's symptoms and increase risk of complications like dehydration or hyperthermia, especially with certain medications.
- Benzodiazepines like lorazepam (0.5-1mg) may be used for short-term management but carry risks of falls and cognitive impairment, as noted in studies 1.
Non-Pharmacological Approaches
- Identifying and addressing triggers of agitation
- Ensuring adequate hydration
- Maintaining a cool environment
- Implementing behavioral strategies
Medication Use
- Any medication should be used at the lowest effective dose with close monitoring for side effects and efficacy.
- Clozapine is also effective but requires blood monitoring, as mentioned in study 1.
- Typical antipsychotics, such as haloperidol, should be avoided in patients with Parkinson's disease due to the risk of extrapyramidal side effects, as warned in study 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Options for Agitated Patients with Parkinson's
- Quetiapine is a preferred atypical antipsychotic for patients with Parkinson's disease, as it is less likely to cause adverse drug-induced parkinsonism 2, 3.
- Clozapine is also a recommended atypical antipsychotic, but its use may be limited by side effects such as somnolence and hypotension 2, 4.
- Pimavanserin is a first-line antipsychotic therapy for Parkinson's disease psychosis, with established safety and efficacy 4.
- Lorazepam, a benzodiazepine, can be used to manage acute agitation, but its use should be cautious due to potential side effects such as dizziness, sedation, and somnolence 5.
Considerations for Summer Months
- Patients with Parkinson's disease may be more susceptible to heat-related illnesses, and medications such as antipsychotics and benzodiazepines may increase this risk.
- Close monitoring of patients is necessary to prevent heat-related complications.
- Non-pharmacological interventions, such as providing sensory, emotional, and environmental support, can be effective in managing agitation and delirium in patients with Parkinson's disease 6.