Topic Overview
The decision to try medicine to treat behaviour problems in
Alzheimer's disease is different for each person. The decision weighs the risks
and benefits of these medicines. Your doctor can help you decide. Medicines for
behaviour problems linked to dementia do not work very well for most people and may have serious risks.
Medicines can be used to treat
behaviour problems caused by
Alzheimer's disease and other diseases that cause
dementia. They should be used only after other non-drug
approaches have failed to improve a person's symptoms. Medicine may be needed
when the person is in danger of harming himself or herself or others or when
the caregiver is unable to deal with the situation using other means.
Antipsychotic medicines
Antipsychotic medicines may help relieve more
severe agitation or psychosis (disordered thought processes).
- Low doses may make the person more comfortable by
reducing certain symptoms, such as delusions, suspicion of others (paranoia),
hallucinations, hostility, or agitation.
- These medicines also may
improve sleep.
- The side effects may make some symptoms of
Alzheimer's disease worse, such as apathy, withdrawal from family and friends,
and inability to think clearly.
- These are powerful medicines. They
commonly cause dizziness, drowsiness, movement disorders that resemble
Parkinson's disease, low blood pressure upon standing (orthostatic
hypotension), and other side effects.
Examples of medicines sometimes used to treat hallucinations,
paranoia, and severe agitation in people with dementia include haloperidol, risperidone (Risperdal), quetiapine (Seroquel), and olanzapine
(Zyprexa).
Health Canada and U.S. FDA advisories. Health Canada and the U.S. Food and Drug
Administration (FDA) have issued advisories stating that people with dementia who use antipsychotics may
die sooner than those who don't use these drugs. Examples of these
antipsychotics include haloperidol, olanzapine (Zyprexa), quetiapine
(Seroquel), and risperidone (Risperdal).
Antianxiety medicines
Antianxiety medicines, including minor
tranquilizers, relieve anxiety and mild agitation and may help calm the person.
But they can cause drowsiness if the dose is too high. When minor tranquilizers
are needed, short-term or occasional use often is better than continuous
use.
Oxazepam and lorazepam (Ativan) are minor tranquilizers
sometimes used to treat dementia. Another antianxiety medicine called
buspirone also can be tried.
- These medicines may increase confusion and upset
the person's balance. This raises the risk of falls.
- A person may
become dependent on these medicines over time, causing even worse symptoms when
he or she suddenly stops taking them. To avoid this problem, these drugs
usually are stopped gradually after a few weeks of use.
Anticonvulsant medicines
Anticonvulsant medicines, such as
carbamazepine (Tegretol) or valproic acid (Depakene), may be used to control
agitation, violent behaviour, and mood swings caused by dementia.
Other medicines
Other medicines that may be used
to treat agitation include trazodone or a selective serotonin reuptake
inhibitor (SSRI) such as fluoxetine (Prozac), sertraline (Zoloft), citalopram
(Celexa), or escitalopram (Cipralex). But research on the effectiveness of these
medicines in Alzheimer's disease and other dementias is limited.
Health Canada and U.S. FDA advisories. Health Canada and the U.S. Food and Drug
Administration (FDA) have issued
advisories on antidepressant medicines and the risk of
suicide. Health Canada and the FDA do not recommend that people stop using these medicines.
Instead, a person taking antidepressants should be watched for
warning signs of suicide. This is especially important
at the beginning of treatment or when the doses are changed.
See Drug Reference for more information about all of these
medicines. (Drug Reference is not available in all systems.)
