Successful treatment of agitation and aggression with prazosin in an elderly patient with dementia and comorbid heart disease

An elderly male with dementia was admitted for increasing aggression and agitation. He was initially treated with risperidone, citalopram, and memantine, as well as nonpharmacological interventions such as behavioral approaches, environmental modifications, and maintaining sleep routines without improvement. He was treated with the addition of the alpha-1 adrenoreceptor antagonist prazosin, with a subsequent reduction in the number of doses of antipsychotic medication needed to maintain appropriate behavior. Prazosin was well tolerated in this patient who had a significant history of heart disease and poor systolic function. Prazosin may represent a relatively safe and effective medication for the treatment of agitation and aggression in patients with dementia, including patients with comorbid cardiac conditions. In this patient, prazosin was better tolerated than the other medications utilized.