Table 7.

Pharmacologic Management of Behavioral Symptoms of Dementia^25,26,45.

	Starting Dose (mg)	Usual/Maximal Dose (mg)	Comments/Side Effects
Antipsychotics
Aripiprazole	2	7–12 QD	Weight neutral, metabolic abnormalities
Olanzapine	2.5	5–10 QD to BID	Weight gain, sedation, metabolic abnormalities
Quetiapine	12.5	50–200 QD to BID	Orthostasis, sedation, metabolic abnormalities
Risperidone	0.25	0.5–1.5 QD to BID	Weight gain, sedation, hyperprolactinemia, metabolic abnormalities. Risk of EPS at higher doses.
Ziprasidone	20	60–80 QD to BID	Less risk of metabolic abnormalities, greater risk of QT prolongation
Other medications
Trazodone	25 QD to BID	50–250 daily	Can use q4h or prior to usual sundowning, or at HS, being careful about maximal dosing. Sedation, orthostasis, rare cardiac conduction abnormalities.
SSRIs	See Table 5 for dosing and considerations
Lamotrigine	25 daily	50–400 daily	Slow titration; observe for Stevens-Johnson syndrome
Gabapentin	100 QD to BID	Up to 1800 in divided doses	Renally excreted
Memantine or cholinesterase inhibitors	Usual dosing

Abbreviations: BID, 2 times a day; EPS, extrapyramidal symptoms; HS, at bedtime; q4h, every 4 hours; QD, every day; QT, QT interval; SSRI, selective serotonin reuptake inhibitor.