Circadian Rhythm Disturbances in Patients with Alzheimer's Disease: A Review

Table 2

Dosing schedule of medications used in CRD.

Symptom	Medication	Initial Dose	Titrating Schedule	Maximum Daily Dose
Insomnia	Trazodone	25 mg hs	25 mg increments q 3–5 days	50–100 mg
	Zolpidem	5 mg hs	5 mg increments q 3-4 days	5–10 mg
	Mirtazapine	15 mg hs	15 mg q week	15–30 mg
	Quetiapine	25 mg hs	25 mg increments q 3-5 days	25–100 mg
	Chloral hydrate	250 mg hs	250 mg increments q 5–7 days	250–1000 mg
Behavioral Dyscontrol	Memantine	5 mg am	5 mg increments q week	20 mg
	Donepezil	5 mg am	5 mg increments in 4 weeks	5–10 mg
	Rivastigmine Transdermal	4.6 mg od	9.5 mg 4 weeks later	9.5 mg
	Galantamine ER	8 mg od	8 mg increments q 4 weeks	16–24 mg
	Risperidone	0.25 mg hs	0.25 mg increments q week	0.5–1.5 mg
	Olanzapine	2.5 mg hs	2.5 mg increments q week	5–10 mg
	Carbamazepine (check level)	100 mg hs	100 mg increments q 3-5 days bid or tid	600 mg
	Oxcarbazepine	300 mg hs	300 mg increments q week	2400 mg
	Divalproex ER (check level)	125 mg hs	125 mg increments q 3-4 days	1500 mg
Excessive Daytime Sleepiness	Methylphenidate	2.5 mg am	2.5 mg increments am and early pm	20 mg
	Modafinil	100 mg am	100 mg increments q week	200 mg
REM Sleep Behavior Disorder	Clonazepam	0.25 mg hs	0.25 mg increment q week	1 mg
	Melatonin	3 mg hs	add 3 mg if needed	6 mg

Adapted from Current management of sleep disturbances in dementia: [60].