Psychotropic drugs in the elderly. Selection of the appropriate agent.

Caution is required when prescribing psychotropic drugs to elderly patients, because of altered pharmacokinetics. Benzodiazepines with a relatively short half-life, such as temazepam (Restoril), alprazolam (Xanax), and lorazepam (Ativan), are better hypnotics for the elderly than those with a long half-life. Lorazepam and clorazepate dipotassium (Tranxene) are appropriate anxiolytics for elderly patients. Antipsychotics have anticholinergic and extrapyramidal symptoms in varying degrees. Thiothixene (Navane) and haloperidol (Haldol) in low doses are the drugs of choice despite their extrapyramidal symptoms. Trazodone (Desyrel) is a good antidepressant for the elderly because of its minimal anticholinergic effects, although it is quite sedating. Desipramine (Norpramin) is the least sedating and has the fewest anticholinergic effects of the tricyclic antidepressants and therefore may be better tolerated. Monoamine oxidase inhibitors and lithium should be used with great caution.