Posted by mard on January 3, 2002, at 16:10:02
In reply to Re: risperdol side effects in the elderly » mard, posted by Cam W. on December 30, 2001, at 3:15:10
Thanks for your thorough response, Cam. (Are you an m.d.?) I think the other drug is Remeron. I don't remember any of her current dosages, but generally docs give her very low doses since she's barely over 100 lbs and she has a pronounced history of hyper-reactivity to drugs. I don't know what all she's hallucinated under, but numerous times she's been hospitalized and a new doc is shocked when we point out her response to a drug ("I've never seen anyone react like this; I gave her a low dose of something that tends to cause no side effects..." etc) One dose of Vicoden the day after she broke her hip and she was in la-la land within a half hour. These drug-induced hallucinations look very different (pointing to imagined items on the wall, with a floating demeanor) from the general responses she's been having lately. I will inquire about other possible causes of her current symptoms.
She's not displaying psychosis now, but is often confused as to place and time. I gather that time is a common theme of dementia, as in "We didn't get home until 3:00 a.m.", or "I've been here for 18 hours and nobody came to help me." She is drowsy, and again having difficulty focusing (symptom went away after Risperdol was cut in half). Before her extremely rapid withdrawal from Klonopin sent her whole body into spasms, she was able to feed herself (May, 2001), but now she cannot get her good hand near her mouth and her tremors are too large to manage anything. She is able to be still when at rest, and her hand tremor only seems to occur when she is attempting to move it. (does that rule out Parkinsonism?)
She apparently has atypical reactions to some drugs compared to other eldrerly. When she was talking agitatedly during the night, and I suggested that she responded well to Tylenol PM when she had bad nights at home, the case manager at the nursing home said "Oh, we don't use that, because so many of the pts become hyper in response to Tylenol PM". They seem unable or unwilling to hear that it did help her sleep. She also got calm when she was given a dose of Klonopin, but I've never seen her respond that way to Ativan. This is all very frustrating. I understand drugs are an art, and a matter of trial and error, but I sure wish the family's experience counted for something. (My frustration ebbs and flows... Sorry to unload.)
Again, thank you.
> Mard - The elderly respond to very low doses of Risperdal™ (risperidone). I have seen doses of 0.25mg and 0.5mg work well in those over 80 years. Unless there is overt psychosis, dose of 1mg per day is as high as the geriatric psychiatrist that I know will raise the Risperdal in this population. When it first came out, much higher doses were used.
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> Most of the side effects, like drowsiness and postural hypotension (dizziness upon rising from a lying down or sitting position) are start-up side effects, and do not usually last longer than a week or two. I would tend to blame the drowsiness on the Ativan™ (lorazepam), which is more sedating, mg to mg, than is Klonopin™ (clonazepam), but Ativan does not tend to build up in the body as readily. I would also like to know what drug was given for "agitated depression". Depending upon the drug, many antidepressants can cause drowsiness in the elderly.
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> Dizziness, depression and confusion are adverse effects of Vasotec™ (enalapril), as well. Again, these effects are seen in the elderly at much lower doses than is seen in younger patients. Ataxia, the ability to co-ordinate movement, is also seen more often in elderly than younger patients taking Vasotec.
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> As for other causes of the jaw tremor; it could be EPS (extrapyramidal syndrome), but this could be tested fairly easily by the doc or a psych nurse. You usually start to see EPS at doses of 3mg/day or more in the elderly (usually about 2mg/day in those who are smaller and over 90 years). If the drug given for "agitated depression" is an SSRI, these drugs have also been know to cause or exacerbate EPS.
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> On the other hand, some elderly have paradoxical reactions to some benzodiazepines, like Ativan. I have seen tremors in different parts of the body induced by Ativan. The Ativan could also be a culpert in the jaw tremor.
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> Or, the symptoms that you see in your mom "could" be due to a combination of adverse effects of some or all of the meds. Or, it could be a result of the natural aging process (eg. the onset of Parkinsonism).
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> This mixed bag of guesses is the main problem with doing several drug changes in a short period of time. It can be very hard to sort out what is going wrong. Even the trauma of experiencing her long time mate having a stroke can affect her physically, as well as mentally.
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> Before asking the doc to drop the Risperdal, perhaps ask the doc what he/she thinks is causing the symptoms that you are noticing. When you get a reasonable answer, then ask the doc what can be done about it.
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>
> BTW, Risperdal is my personal choice of antipsychotic, in the elderly. I find that Seroquel™ (quetiapine) doesn't always work, and is too sedating. Zyprexa™ (olanzapine), because of it's anticholinergic effects, must be used carefully in the elderly because this can cause falls from stumbling. Zyprexa is also more sedating than Risperdal. With Geodon™ (ziprasidone) I have absolutely no experience, so I cannot make any comment.
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> Sorry that I have no definite answers for you; all I can give a bunch of guesses. All that I can say is that the symptoms you describe are not entirely typical with a reasonably low dose of Risperdal in an elderly person.
>
> - Cam
poster:mard
thread:87991
URL: http://www.dr-bob.org/babble/20020103/msgs/88653.html