Which medications in the drug class Antipsychotics, 2nd Generation are used in the treatment of Lewy Body Dementia?

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

Antipsychotics, 2nd Generation

Patients with DLB frequently have hallucinations that can cause them to engage in unsafe behavior; these patients therefore require treatment. Standard neuroleptics exacerbate parkinsonian motor features and, consequently, are contraindicated.

Clozapine (Clozaril, FazaClo)

Clozapine is associated with the risk of agranulocytosis when it is used at doses required for the treatment of schizophrenia with symptoms refractory to standard neuroleptics. In the United States, weekly dosing and a weekly CBC are required to dispense the drug. Discontinuing therapy at the first sign of leukopenia decreases, but does not eliminate, the risk of agranulocytosis. Whether agranulocytosis is associated with low doses in elderly patients and in patients with dementia is not clear.

Quetiapine (Seroquel)

Quetiapine is an atypical neuroleptic that may act by antagonizing dopamine and serotonin effects. It is also used to treat insomnia.

Aripiprazole (Abilify)

Aripiprazole improves positive and negative schizophrenic symptoms. Its mechanism of action unknown, but it has been hypothesized that the drug works differently than other antipsychotics do. Aripiprazole is thought to be a partial dopamine (D2) and serotonin (5HT1A) agonist and to antagonize serotonin (5HT2A). Additionally, no QTc interval prolongation has been noted in clinical trials. Aripiprazole is available as a tablet, an orally disintegrating tablet, and an oral solution.


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