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Treatment of Behavioral Symptoms: When to Consider Antipsychotic Medications in LBD - Page 4

Antipsychotic Medications

In diseases such as schizophrenia, behavioral symptoms like hallucinations and delusions can be controlled using antipsychotic medications (also called neuroleptics).  But in LBD, using antipsychotic medications can be problematic.

We do not know why, but many people with LBD who are treated with antipsychotic medications have very severe reactions. Their cognitive symptoms can become worse and they may appear more sedated. In addition, they may have increased symptoms of parkinsonism. Also, in rare cases, antipsychotic medications may cause a condition called “neuroleptic malignant syndrome” (NMS), which causes severe fever, muscle rigidity and may lead to kidney failure and death.  So physicians must be very careful when prescribing antipsychotic medications for someone with LBD.

There are two types of antipsychotic medications: the typical (or traditional) antipsychotics and the newer, antipsychotics.

The typical antipsychotics were the first antipsychotics developed and should NOT be prescribed for people with LBD.  Typical antipsychotics include:

  • chlorpromazine (Thorazine)
  • droperidol (Inapsine)
  • fluphenazine (generic only)
  • haloperidol (Haldol)
  • loxapine (Loxitane)
  • molindone (Moban)
  • perphenazine (generic only)
  • pimozide (Orap)
  • thioridazine (generic only)
  • thiothixene (Navane)
  • trifluoperazine (Stelazine)

The newer or atypical antipsychotics may be helpful for people with LBD if used conservatively. Atypical antipsychotics include:

  • aripiprazole (Abilify)
  • clozapine (Clozaril)
  • fluoxetine & olanzapine (Symbyax)
  • iloperidone (Fanapt)
  • olanzapine (Zyprexa)
  • paliperidone (Invega)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)

Many LBD experts prefer quetiapine or clozapine to control difficult behavioral symptoms.

Clozapine requires frequent blood tests to monitor for the development of potential blood problems. Both quetiepine and clozapine should be given at the lowest dose possible and for the shortest length of time possible to control symptoms.

Some atypical antipsychotic medications (like olanzapine and risperidone) should be avoided if possible, because they have higher incidences of side effects, such as increased parkinsonism, sedation, and orthostatic hypotension. Ask your loved one’s physician about possible side effects on motor function before he or she prescribes an atypical antipsychotic medication.

Caregivers should note that several years ago the U.S. Food and Drug Administration (FDA) issued a warning that all antipsychotic medications, both atypical and typical, increase the risk of death in elderly patients with dementia (this includes people with LBD). Doctors and families should discuss the risks associated with antipsychotic medication use, including the side effects of the medication, against the risks of potential physical harm and distress to the patient or caregivers as a result of behavioral symptoms. Caregivers should contact the doctor about any side effects they observe that do not go away within a few days.