An 88-year-old woman with Alzheimer-type dementia who lives in a long-term care home is seen for an annual medication review after two falls without injury in the past 3 months. Risperidone 1 mg BID was started 14 months ago for verbal and physical agitation during personal care, and staff report that her behaviour has been calm and unchanged for the past 10 months. Her other medications are zopiclone 5 mg at bedtime for 3 years, pantoprazole 40 mg daily started 3 years ago for dyspepsia that resolved, aspirin 81 mg daily, donepezil 10 mg daily, amlodipine 5 mg daily, vitamin D, and acetaminophen as needed. She has no history of myocardial infarction, stroke, peripheral arterial disease, atrial fibrillation, or gastrointestinal bleeding. On examination she is drowsy but oriented to person, with mild bilateral rigidity and a shuffling gait; standing BP is 110/64 mm Hg. Creatinine clearance is 38 mL/min (>60).
| Heart rate | 68/min |
| Respiratory rate | 16/min |
| Temperature | 36.6 °C |
| O2 saturation | 96%, room air |
| Blood pressure | 128/72 mm Hg (sitting) |
Question 1 of 30
Which one of the following is the most appropriate management of her risperidone?
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