Document Detail


Aripiprazole in the treatment of Alzheimer's disease.
MedLine Citation:
PMID:  23350964     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Psychosis is a common and difficult to treat symptom in Alzheimer's disease (AD). It is a cause of diminished quality of life and caregiver distress. Atypical antipsychotics are frequently used for the treatment of dementia-related psychosis, despite FDA warnings because of increased mortality associated with the use of these medications in dementia patients. Aripiprazole is a newer atypical antipsychotic drug with partial agonist activity at dopamine receptors and antagonist activity at 5-HT(2A) receptors, with a low side-effect profile.
AREAS COVERED: This descriptive review gives a short overview of the pathology and epidemiology of AD, including psychotic symptoms, and describes the mode of action of aripiprazole and results of preclinical studies. Finally, randomized controlled trials evaluating the use of aripiprazole in AD-related psychosis and agitation are discussed. Whenever relevant, meta-analytical data from literature are referred to.
EXPERT OPINION: In randomized placebo-controlled clinical trials, aripiprazole shows modest efficacy in the treatment of AD-related psychosis. Neuropsychiatric symptoms alleviated were predominantly psychotic features and agitation. In individual trials, aripiprazole was generally well tolerated, serious side effects were seldom reported and included accidental injury and somnolence. Meta-analyses however demonstrated increased mortality as a class effect for atypical, but also for typical antipsychotics. No increased cardiovascular outcomes, cerebrovascular accidents, increased appetite or weight gain were demonstrated in meta-analyses for aripiprazole-treated patients with psychosis of dementia. Aripiprazole was found to induce sedation. Aripiprazole should only be used in selected patient populations resistant to non-pharmacological treatment with persisting or severe psychotic symptoms and/or agitation, and in which symptoms lead to significant morbidity, patient suffering and potential self-harm. The indication for continuing treatment should be revised regularly.
Authors:
Peter Paul De Deyn; Annemieke F J Drenth; Berry P Kremer; Richard C Oude Voshaar; Debby Van Dam
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-28
Journal Detail:
Title:  Expert opinion on pharmacotherapy     Volume:  14     ISSN:  1744-7666     ISO Abbreviation:  Expert Opin Pharmacother     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-08-12     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  100897346     Medline TA:  Expert Opin Pharmacother     Country:  England    
Other Details:
Languages:  eng     Pagination:  459-74     Citation Subset:  IM    
Affiliation:
University of Groningen, University Medical Center Groningen, Alzheimer Research Center, Department of Neurology, 9713 GZ Groningen, The Netherlands. p.p.de.deyn@umcg.nl
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MeSH Terms
Descriptor/Qualifier:
Alzheimer Disease / drug therapy*,  epidemiology,  metabolism,  psychology
Antipsychotic Agents / administration & dosage,  adverse effects,  therapeutic use*
Dopamine Agonists / administration & dosage,  adverse effects,  therapeutic use*
Humans
Meta-Analysis as Topic
Off-Label Use
Piperazines / administration & dosage,  adverse effects,  therapeutic use*
Psychotic Disorders / drug therapy*,  epidemiology,  metabolism
Quinolones / administration & dosage,  adverse effects,  therapeutic use*
Randomized Controlled Trials as Topic
Receptor, Serotonin, 5-HT2A / metabolism
Receptors, Dopamine / metabolism
Serotonin 5-HT2 Receptor Antagonists / administration & dosage,  adverse effects,  therapeutic use*
Chemical
Reg. No./Substance:
0/Antipsychotic Agents; 0/Dopamine Agonists; 0/Piperazines; 0/Quinolones; 0/Receptor, Serotonin, 5-HT2A; 0/Receptors, Dopamine; 0/Serotonin 5-HT2 Receptor Antagonists; 82VFR53I78/aripiprazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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