Dosing of neuroleptics in elderly demented patients with aggressive and agitated behaviour: A double-blind study with zuclopenthixol

Abstract

A double-blind controlled trial was carried out in 73 hospitalized elderly patients to evaluate the effect of different low doses of the neuroleptic, zuclopenthixol, on behavioural disorders associated with dementia. Patients were randomized into four groups and received treatment for 4 weeks with fixed daily doses of 2 mg, 4 mg or 6 mg zuclopenthixol, or with a dose which could be increased from 4 mg to 20 mg daily. The dose could also be reduced if necessary. Fifty-four of the patients remained on the same daily dose throughout the study. The results of symptom assessments showed that there was a significant improvement from baseline scores in all of the dose groups and, with the exception of patients on 2 mg daily, this was evident after only 1 week of treatment. Although improvement was noted in all the symptoms evaluated, the best effect was achieved on aggressive behaviour, restlessness/agitation, sleep disorders, and shouts/torments others. Only a few, relatively mild side-effects were recorded and there was no increase in frequency with increasing doses. There was significant correlation between the serum concentration and the dose of zuclopenthixol used but not in connection to age and clinical efficacy.

Mental health nursing practice in acute psychiatric close‐observation areas

“…The serious sequelae that can result from its misuse has been documented (Hughes 1999;Malhi et al . 1999;Nygaard et al . 1994).…”

Long-term efficacy of olanzapine in the control of psychotic and behavioral symptoms in nursing home patients with Alzheimer's dementia

“…Caution is suggested with the use of thioridazine, which has been said by some to have only an anxiolytic effect to support its use, while excessive side effects may warrant its reconsideration (Kirchner et al, 2000). More recent results with thiothixene (Finkel et al, 1995) have been encouraging, as have the ®ndings with zuclopenthixol, of which both oral administration (Nygaard et al, 1994) and intramuscular depot injection (Robles et al, 1996) have demonstrated signi®-cant ef®cacy of this agent, with minimal extrapyramidal toxicity.…”

Veterinary issues related to bears (Ursidae)

“…Zuclopenthixol is a neuroleptic dopamine D1/D2 receptor antagonist and has been used successfully to reduce aggressive interactions in two group-housed < Asiatic black bears (at a dose of 0 Á 3-0 Á 5 mg kg À 1 orally once daily), based on evidence extrapolated from other species (Manzaneque & Navarro, 1999). Zuclopenthixol has also been used extensively in human patients to alleviate aggression associated with dementia or psychosis (Nygaard et al, 1994). No side effects from its use have been recorded in bears.…”