If an etiology is identified, a targeted therapy can be provided; however, delays in evaluation may require empiric treatment for patient comfort. 1 It is reasonable to begin with a trial of a phenothiazine, such as prochlorperazine, because these medications are effective in a range of clinical situations. A trial of a prokinetic agent (., metoclopramide [Reglan]) may then be beneficial. Serotonin antagonists (., ondansetron [Zofran]) are effective and are better tolerated than phenothiazines and prokinetics, but their high cost (approximately $20 per dose, even for the recently approved generic ondansetron) makes long-term use impractical. Trials determining the specific effectiveness of medications for nausea and vomiting are limited; therefore, a trial of any medication may be reasonable on an individual basis. 1 Antiemetic agents commonly used for nausea and vomiting are listed in Table 4 1 , 2 , 6 ; therapies for known etiologies of nausea and vomiting are listed in Table 5 2 , 20 – 26 ; and alternative therapies are listed in Table 6 . 22 , 27 – 29
An assessment for an underlying cause of behavior is needed before prescribing antipsychotic medication for symptoms of dementia .  Antipsychotics in old age dementia showed a modest benefit compared to placebo in managing aggression or psychosis, but this is combined with a fairly large increase in serious adverse events. Thus, antipsychotics should not be used routinely to treat dementia with aggression or psychosis, but may be an option in a few cases where there is severe distress or risk of physical harm to others.  Psychosocial interventions may reduce the need for antipsychotics.