Psychotropics

Dose

Comments

Haloperidol

– Initial dose: 0.25 mg in frail older patients (0.5-1 mg in robust or younger patients)

– May be given PO, SC, IM, or IV

– May be given every 4 h, not exceeding 2 mg in a 24-h period in older patients

– FDA “black-box warning” for risk of arrhythmia and death when dose is >10 mg in a 24-h period in patients of all ages

– Parenteral route available

– May cause QT prolongation

Risperidone

– Initial dose: 0.25 mg in frail older adults (0.5 mg in robust or younger patients)

– May be given bid, not exceeding 2 mg in a 24-h period in older patients

– PO only

– May cause QT prolongation

Quetiapine

– Initial dose: 6.25-12.5 mg in frail older patients (25 mg for robust or younger patients)

– May be given bid

– PO only

– Increased risk of sedation

– May cause QT prolongation

– Least likely to cause extrapyramidal adverse effects. Can be considered in patients with Parkinson disease

Lorazepam or other benzodiazepine

– For lorazepam, initial dose 0.5 mg

– May be given PO, SC, IM, or IV

– Use for alcohol withdrawal

– Consider in patients with Parkinson disease