Drug	Dosage and route	Adverse effects	Considerations
Antipsychotics
Droperidol	IM: 5 to 10 mg as monotherapy or in combination with a benzodiazepine; up to 20 mg daily IV: 2.5 to 10 mg, may repeat dose every five minutes until acute symptoms are controlled; up to 20 mg daily No renal adjustment is necessary	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, central nervous system depression, esophageal dysmotility, falls, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	FDA boxed warning: increased mortality in older patients with dementia-related psychosis
Haloperidol	Oral: 0.5 to 1 mg; repeat dose every six hours as needed; up to 30 mg daily IM/IV: 0.5 to 1 mg; repeat dose every 30 minutes until acute symptoms are controlled; up to 30 mg daily No renal adjustment is necessary	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, central nervous system depression, esophageal dysmotility, falls, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	Contraindicated in Parkinson disease, severe central nervous system depression, Lewy body dementia
Atypical antipsychotics
Aripiprazole	Oral: 2 to 5 mg once daily; up to 15 mg once daily No renal adjustment is necessary	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, metabolic syndrome, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	FDA boxed warning: increased mortality in older patients with dementia-related psychosis
Olanzapine (Zyprexa)	Oral: 5 to 10 mg once (or 2.5 mg once daily in patients older than 60 years); up to 20 mg daily IM: 5 to 10 mg once; may repeat after two to four hours if needed; up to 30 mg daily No renal adjustment is necessary	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, metabolic syndrome, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	FDA boxed warning: increased mortality in older patients with dementia-related psychosis
Quetiapine	Oral: 12.5 mg twice daily or 25 to 50 mg at bedtime; up to 400 mg daily No renal adjustment is necessary	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, metabolic syndrome, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	Randomized controlled trials comparing effectiveness with haloperidol showed comparable response rates
Risperidone (Risperdal)	Oral: 0.5 mg twice daily; up to 6 mg daily Creatinine clearance of 30 to 60 mL per minute: administer 50% to 75% of the usual dose Creatinine clearance of 10 to less than 30 mL per minute: administer 50% of the usual dose Creatinine clearance less than 10 mL per minute: consider an alternative agent	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, metabolic syndrome, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	FDA boxed warning: increased mortality in older patients with dementia-related psychosis
Ziprasidone	Oral: 20 to 40 mg twice daily with meals; up to 80 mg daily IM: 10 mg daily; up to 40 mg daily No renal adjustment is necessary	Extrapyramidal syndrome, prolonged QT interval, anticholinergic effects, hematologic abnormalities, metabolic syndrome, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension	FDA boxed warning: increased mortality in older patients with dementia-related psychosis
Benzodiazepines
Lorazepam	Oral/IM/IV: 0.5 to 2 mg every four to six hours as needed; up to 10 mg daily No renal adjustment is necessary	Sleep disturbances, paradoxical excitation, respiratory depression, anterograde amnesia, excessive sedation, confusion	May worsen delirium Treatment limited by adverse effects
Midazolam	IM/IV: 2.5 to 5 mg; up to 20 mg daily No renal adjustment is necessary	Sleep disturbances, paradoxical excitation, respiratory depression, anterograde amnesia, excessive sedation, confusion	Indicated for seizures and alcohol or hypnotic withdrawal
Anesthetics
Ketamine	IM: 4 to 6 mg per kg; may repeat dose once five to 10 minutes after the initial dose; up to 200 mg daily IV: 0.5 to 1 mg per kg; may repeat dose once 10 to 25 minutes after initial dose using 2 to 3 mg per kg; up to 500 mg daily No renal adjustment is necessary	Laryngospasm, increased blood pressure, increased heart rate, cardiac arrhythmia, genitourinary effects, respiratory depression	Use with caution in patients with cardiovascular disease
Antidepressants
Trazodone	Oral: 25 to 50 mg once daily at bedtime; up to 300 mg daily No renal adjustment is necessary	Increased risk of bleeding, cardiac arrhythmias, orthostatic hypotension, serotonin syndrome, suicidal thinking and behavior	May worsen and prolong delirium symptoms