Which medications are used in the management of dementia with Lewy bodies (DLB)?

Updated: Aug 08, 2019
  • Author: Howard A Crystal, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Patients who have DLB with mild hallucinations and agitation may not require medical treatment. When medication is used, acetylcholinesterase inhibitors should be tried first. When cholinesterase inhibitors are ineffective, most experts recommend atypical neuroleptics such as clozapine, quetiapine, or aripiprazole. Avoid standard neuroleptics, such as haloperidol, because of neuroleptic sensitivity.

Pharmacotherapy

As yet, no compelling data indicate that medications can decrease the rate of cognitive decline. Medications can be used to treat agitation and hallucinations, as well as depression, and to improve cognition and/or alertness.

The following medications are used in patients who have DLB:

  • Cholinesterase inhibitors (eg, donepezil, rivastigmine, rivastigmine patch, galantamine)

  • 2nd-generation antipsychotics (eg, clozapine, quetiapine, aripiprazole)

  • Antidepressants (eg, venlafaxine, paroxetine, sertraline, fluoxetine)

  • Benzodiazepines (eg, clonazepam)

  • Dopamine precursors (eg, levodopa and carbidopa)

See Treatment and Medication for more detail.


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