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Is increased Risperdone dosage advisable for treatment of dementia?

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Posted on Wed, 12 Mar 2014
Question: my mother was in high care and they increased her risperdone from .5 to 5mg and didnt tell when i complained they said her deminture was very bad not true i used to see her nearly every day and she had short term memory long term very good
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Answered by Dr. Lav Kaushik (28 minutes later)
Brief Answer: High dose of antipsychotic not suited for Dementia Detailed Answer: Hello. You see there are two issues that i will like to address here which you may then bring up in your talk with the doctor/s treating your mother with an underlying dementia. 1) A direct increase in dose from 0.5 mg to 5 mg is not recommended as it may lead to imbalance of the drug levels in the blood stream thereby raising risk of side effects like somnolence / increasing sleepiness, increased risk of seizures, extrapyramidal side effects like tremors , dystonia, akathisia, hyperprolactinemia, blood pressure and heart rate fluctuations, all of which can be serious enough to further worsen her dementia. Therefore if at all there was an imminent need found by the doctor to up the dose of risperidone to counter her behavioural component of dementia then he /she should have taken a more systematic approach of titrating the dose to 1 mg first and then after 1 week further increment could have been considered by 0.25-0.5 mg every week. 2) In old age there always remains a risk with the use of high dose of anti psychotics like risperidone and others because almost all of them invariably can lower seizure threshold and precipitate seizures and in addition to this these anti psychotics at higher dose also make the old person more vulnerable to development of stroke or TIA. So I reckon that you discuss these fine points with your doctor so as to convince him / her to bring the dose down to 1 mg / day at night time and maintain her on this dose for 2 weeks at least before thinking of going further up the dose. I hope this answers your query. You are free to ask a follow up question. If there is further clarification needed by you then you kindly rate the answer and close this discussion. Thank you for allowing us to serve you. Regards
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Lav Kaushik

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Practicing since :2004

Answered : 112 Questions

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Is increased Risperdone dosage advisable for treatment of dementia?

Brief Answer: High dose of antipsychotic not suited for Dementia Detailed Answer: Hello. You see there are two issues that i will like to address here which you may then bring up in your talk with the doctor/s treating your mother with an underlying dementia. 1) A direct increase in dose from 0.5 mg to 5 mg is not recommended as it may lead to imbalance of the drug levels in the blood stream thereby raising risk of side effects like somnolence / increasing sleepiness, increased risk of seizures, extrapyramidal side effects like tremors , dystonia, akathisia, hyperprolactinemia, blood pressure and heart rate fluctuations, all of which can be serious enough to further worsen her dementia. Therefore if at all there was an imminent need found by the doctor to up the dose of risperidone to counter her behavioural component of dementia then he /she should have taken a more systematic approach of titrating the dose to 1 mg first and then after 1 week further increment could have been considered by 0.25-0.5 mg every week. 2) In old age there always remains a risk with the use of high dose of anti psychotics like risperidone and others because almost all of them invariably can lower seizure threshold and precipitate seizures and in addition to this these anti psychotics at higher dose also make the old person more vulnerable to development of stroke or TIA. So I reckon that you discuss these fine points with your doctor so as to convince him / her to bring the dose down to 1 mg / day at night time and maintain her on this dose for 2 weeks at least before thinking of going further up the dose. I hope this answers your query. You are free to ask a follow up question. If there is further clarification needed by you then you kindly rate the answer and close this discussion. Thank you for allowing us to serve you. Regards