NOTE: These drug carry a black box warning from the FDA and are not approved for this indication.
Contraindications to antipsychotic drug therapy:
(1) dementia with Lewy bodies (see above)
Steps that can help reduce the risk of adverse side effects of antipsychotic drugs in demented patients:
(1) Use these drugs only in severe cases that have failed all other types of therapy (therapy of last resort).
(2) Therapy should only be for a short period of time. However, serious reactions have occurred even with short term therapy.
(3) Use the lowest possible dose. Adjust the dose for comorbid conditions and concurrent medications, especially those resulting in drug accumulation.
(4) Monitor the patients closely for early signs of adverse effects.
(5) Keep the patient's representative informed.
(6) An atypical antipsychotic agent may have fewer side effects than a first generation (typical) drug.
Adverse effects to watch for:
(1) sudden physical deterioration
(2) sudden cognitive decline and/or impaired consciousness
(3) orthostatic hypotension or other autonomic symptoms
(4) extrapyramidal symptoms
(5) neuroleptic malignant syndrome
(6) marked worsening of Parkinsonian symptoms
(7) anticholinergic effects
(8) somnolence
(9) cerebrovascular or cardiovascular events
