Table 8: Short- and Long-Acting Drugs (Continued) Drugs
Geriatric Dosage (mg per day)* Anxiety Insomnia
Onset of Action
Chlordiazepoxide (Librium)
20
20
Intermediate
Clonazepam (Klonopin)
1.5
1.5
Intermediate
Clorazepate (Tranxene)
15
15
Fast
Diazepam (Valium)
5
5
Very fast
Flurazepam (Dalmane)
15
15
Very fast
Halazepam (Paxipam)
40
20
Slow
Prazepam (Centrax)
15
15
Slow
Quazepam (Doral)
7.5
7.5
Intermediate
Antipsychotic Drugs Antipsychotics should be reserved as a last resort in the management of behavioral problems in the elderly due to their side effects. The common side effects reported in the geriatric population include sedation, anticholinergic effects, orthostatic hypotension, extrapyramidal symptoms, and tardive dyskinesia. Extrapyramidal symptoms include dystonic reactions, pseudo- parkinsonism, and akathisia. The extrapyramidal reactions resolve on discontinuation of antipsychotic drugs. Dystonic
reactions are acute spasms of muscle groups and can result in a fixed upward gaze, neck twisting, and facial muscle spasms causing grimacing, a clenched jaw, and difficulty with speech. Akathisia presents as a form of agitation with symptoms, including an inability to sit still, pacing, restlessness, foot tapping, and rocking and shifting of weight while standing. Table 9 summarizes antipsychotic drugs.
Table 9: Antipsychotic Drugs Drugs
Geriatric Dosage (mg per day)
Side Effects Sedation Extrapyram-idal Effects
Anticho- linergic Effects
Orthostatic Hypotension
Tardive Dyskinesia
Chlorpromazine (Thorazine)
75
High
Moderate
Moderate High
Yes
Fluphenazine (Prolixin)
4
Low
High
Low
Low
Yes
Mesoridazine (Serentil)
25
High
Low
High
Moderate
Yes
Prochlorperazine (Compazine)
10
Moderate High
Low
Low
Yes
Promazine (Sparine)
150
Moderate Moderate
High
Moderate
Yes
Trifluoperazine (Stelazine)
8
Low
High
Low
Low
Yes
Triflupromazine (Vesprin)
20
High
Moderate
High
Moderate
Yes
Thioridazine (Mellaril) Thioxanthene Thiothixene (Navane) Butyrophenone Haloperidol (Haldol) Dibenzoxazepine Loxapine (Loxitane) Dihydroindolone Molindone (Moban) Atypical antipsychotics Clozapine (Clozaril)
75
High
Low
High
High
Yes
7
Low
High
Low
Moderate
Yes
4
Low
Very high
Low
Low
Yes
10
Low
Moderate
Low
Low
Yes
10
Moderate Moderate
Low
Low
Yes
50
High
Low
High
Moderate
Low
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