Posted by Cam W. on December 30, 2001, at 3:15:10
In reply to risperdol side effects in the elderly, posted by mard on December 27, 2001, at 20:50:49
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.
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.
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.
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.
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.
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).
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.
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.
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.
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:Cam W.
thread:87991
URL: http://www.dr-bob.org/babble/20011222/msgs/88211.html