Zyprexa Dosage in Elderly Non-pharmacological treatments for behavioral disorders should be tried before medicines are needed to allow patient care. Non-pharmacological approaches can be useful in the treatment of behavioral disorders before medicines are needed.
Dosage Forms & Strengths
tablet, orally disintegrating
IM injection, short-acting
IM injection, extended-release suspension
Quetiapine and clozapine are also recommended for treating psychosis in some patients with Parkinson’s disease. However, OlanZapin isn’t approved for the treatment of patients with dementia-related psychosis.
Old age is the number one risk factor for dementia, which is often associated with behavioral disturbances and psychosis in addition to cognitive and memory impairment. Elderly persons with dementia–especially those who are agitated or aggressive–tend to be placed in nursing homes and treated with antipsychotic medications. The majority of the studies of antipsychotic efficacy and safety have been conducted in young schizophrenic patients. Still, there are differences in dosing schedules, efficacy, and compliance when these medications are used in older patients with dementia and psychosis. An overview of both nonpharmacologic and pharmacologic therapy is presented to treat elderly dementia patients, particularly those residing in long-term care centers.
The fastest-growing sector of the population is made up of individuals over age 85 years. 1 From the year 2000, more than 35 million people will be more than 65 years old, and an additional 5 million people will be more than 85 years old. The trend toward a longer life span increases the demand for long-term maintenance facilities. Presently, the 16,500 nursing homes in America have approximately 2 million inhabitants. Of the 2.2 million persons who became 65 years old in 1990, nearly half will enter a nursing home in their lifetime.
Additionally, hospitals release convalescent patients earlier, forcing nursing homes and skilled nursing facilities to take a bigger role in subacute care. Regrettably, dementia frequently presents with psychosis; consequently, many older patients have been treated with antipsychotic medications. The majority of the studies of antipsychotic efficacy and safety have been done in schizophrenic patients. Still, there are differences in dosing schedules, efficacy, and compliance in older patients with dementia with psychosis. This guide will discuss the nonpharmacologic and pharmacologic treatment of psychosis in elderly patients with dementia, particularly those residing in long-term care centers.
Patients with schizophrenia signs may have a different tolerance to olanzapine in elderly patients than in younger patients. However, clinical trials of the Zyprexa-fluoxetine combination did not involve enough patients over 65 years old to determine whether they responded and younger patients. In addition, older patients are more likely to suffer from dementia and age-related liver, kidney, and heart problems, which in patients taking olanzapine may require caution and dose adjustment.
This medicine isn’t approved for treating patients with dementia or related psychosis. Your doctor will decide whether to treat you with this medication or not and whether to alter other medications you’re taking. The use of any of the medications in the following medications isn’t recommended but may be necessary sometimes.
The safety and efficacy of oral olanzapine have not been proven in patients under 13 years old. The safety and/or effectiveness of the combination of oral olanzapine and fluoxetine hasn’t been proven in any individual under ten years of age. The safety and efficacy of prolonged-release injections haven’t yet been demonstrated for patients older than 18 years.
In dementia-related psychosis and behavioral disorders, olanzapine isn’t suggested for use in patients with these disorders due to the higher risk of death from cerebrovascular accidents.
In a placebo-controlled clinical trial lasting 6-12 weeks in elderly patients with dementia-related psychosis and/or disordered behavior (mean age 78 years), mortality in olanzapine patients doubled (3.5% vs. 1.5%) compared to patients treated with placebo. However, the frequency of death wasn’t connected with the olanzapine dose (mean daily dose of 44 mg) or the duration of treatment.
People with dementia who take antipsychotic drugs like Zyprexa have a higher risk of sudden death. In addition, older patients with dementia and related psychosis treated with antipsychotics have an increased risk of death.
In general, older patients are more vulnerable to antipsychotic-induced adverse events, at least partially due to pharmacokinetic and pharmacodynamic changes caused by the normal aging process34, 35 Older patients often have more comorbidities because of taking more medications, increasing their risk of drug interactions.
The risk of developing tardive dyskinesia is increased in non-schizophrenic elderly patients who are given these medications.
Sweet and Pollock14 pointed out that controlled clinical trials of atypical antipsychotics in older patients are necessary due to age-related changes in pharmacokinetic risk and drug interactions and shouldn’t be extrapolated from numerous case studies in young patients with schizophrenia. A MEDLINE search of the National Library of Medicine database revealed few studies of this atypical antipsychotic use of patients with dementia compared to schizophrenia-free patients and no information on side effects pertinent to elderly demented patients.
In nursing homes, 46 percent of residents receive psychoactive medications, including antipsychotics (17 percent ), anxiolytics (15%), antidepressants (24%), and hypnotics (5 percent ) .11 Antipsychotic treatment options for psychotic behavioral disorders A meta-analytical review of 33 studies comparing conventional antipsychotics and placebo in elderly dementia patients with stress found that the former had positive treatment effects in the dose group of 2-3 mg / d. 12 Placebo-controlled dose comparisons with Haloperidol for psychosis and disruptive behavior in 71 outpatient ADHD. Thus, new antipsychotics may have fewer side effects than conventional antipsychotics such as Haloperidol.14 Studies of new antipsychotics to treat behavioral symptoms in ADHD are warranted. A large meta-analysis of clinical trials revealed a 1.5-1.7-fold increased death risk associated with antipsychotic use compared to placebo in elderly patients with dementia 52-53. The most common cause of death was coughing, pneumonia, and associated complications like sudden cardiac death.
A published randomized controlled trial (RCT) reported comparable effectiveness of short-acting olanzapine (I-BE) and Zyprexa (intramuscular) in combination with Haloperidol and lorazepam. Another study compared I-BE with Zyprexa and the mix of Haloperidol with Lorazepam.
Short-acting olanzapine (IM-Zyprexa, intramuscular) is approved in many countries, including Canada and the United States, to treat acute anxiety related to schizophrenia and bipolar disorder (6). In adults, it has been shown effective in treating arousal disorders associated with schizophrenia, borderline personality disorder, bipolar disorder, and alcohol and drug use in patients (7-12).
Olanzapine (Zyprexa) is not approved for use in older adults with dementia by the US Food and Drug Administration (FDA) to treat psychosis. It belongs to a group of new antipsychotics called atypical antipsychotics. These drugs are viewed as a better choice for those with Alzheimer’s than other older antipsychotic drugs. S
Olanzapine is a member of a category of drugs called psychotropic drugs that affect the mind. It blocks the action of drugs used to treat Parkinson’s disease, such as levodopa, carbidopa, Sinemet (r), bromocriptine, pramipexole (Mirapex (r)) and ropinirole (Requip (r)), among others.
GPs are most likely to treat schizophrenia in older patients, and it’s typical for them to treat patients with Alzheimer’s and Parkinson’s. These patients may exhibit psychotic symptoms that can be treated with special aids. Atypical first and second-generation antipsychotics are associated with a greater risk of death in elderly patients when used for dementia-related psychosis.
Typical antipsychotics such as Halo, Peridot, and Haldol are utilized to control psychotic behavior and disorders in elderly patients, but these drugs can have troubling side effects.
It’s not used to treat behavioral problems in older adults or individuals with dementia or Alzheimer’s disease. However, it can be used together with fluoxetine to treat the melancholy component of bipolar disorder or manic depression or depression in patients who have received other antidepressants which are not working. Additionally, it is used with other medications (e.g., Lithium or valproate) to deal with mania (mixed episodes), which is part of bipolar disorder.