Use of aripiprazole for delirium in the elderly: a short review

Abstract

The effects and tolerability of antipsychotics in delirium treatment remain controversial. Compared to other antipsychotics, aripiprazole differs in pharmacological activity because it exerts its effect as a dopamine D2 partial agonist. The guidelines of the American Psychiatric Association rank aripiprazole highly among antipsychotics with regard to safety, and this drug is likely to be useful for delirium treatment. Here, we reviewed the efficacy and safety of aripiprazole for delirium. The results of our literature review on the efficacy and safety of delirium treatments suggest that aripiprazole is an effective treatment option for delirium in the elderly. Aripiprazole is as effective as other antipsychotics in improving delirium symptoms, and it is safer because it is less likely to cause extrapyramidal symptoms, excessive sedation, and weight gain. However, these findings are based on only a few clinical studies of elderly patients with delirium. Therefore, further investigations are necessary.

Consensus statements on the clinical usage and characteristics of aripiprazole for Hong Kong

“…In the panellists' experience, the dopamine partial agonist has been used to alleviate psychosis‐associated dementia and agitation in the elderly, with favourable tolerability. Clinicians in other nations have reported the efficacy of aripiprazole in the treatment of delirium in older patients and the improvement of anorexia nervosa in adolescents 11,12 . Pre‐clinical evidence demonstrated the anti‐nociceptive effect of aripiprazole, implying its potential use for pain relief 13 .…”

“…The use of aripiprazole for the treatment of dementia‐related psychosis should be explored.The use of anti‐psychotics, including aripiprazole, in elderly patients with dementia‐related psychosis has been restricted by the FDA in the United States with a box warning, because of the possibility of elevated risks of mortality and cerebrovascular events 39 . Nevertheless, a review that included case reports and open‐label trials suggests that aripiprazole is effective in improving delirium in elderly patients and seems to be safer than other SGAs because it is associated with fewer reports of EPS, metabolic disturbance, weight gain and excessive sedation 11 . Moreover, many studies have shown the tolerability of aripiprazole in older psychiatric patients 35–39 .…”

Potentially inappropriate medications according to PRISCUS list and FORTA (Fit fOR The Aged) classification in geriatric psychiatry: a cross-sectional study

“…Remarkably, aripiprazole was the second most frequently prescribed FORTA class D drug in our study population. Yet, aripiprazole does have certain advantages in elderly patients, for example comparatively low risks of QT c interval prolongation or extrapyramidal motor disturbances and only mild anticholinergic side effects (Kirino 2015 ; Pahwa et al 2021 ). Notwithstanding, a Dear Doctor Letter in 2005 pointed out the higher risk of cerebrovascular events with aripiprazole therapy in patients with behavioral disturbances in the context of dementia, so the use of this agent in elderly patients should certainly be viewed critically (Wang et al 2007 ).…”

Exploratory and Confirmatory Factor Analyses of Delirium Symptoms in a Sample of Nursing Home Residents

“…In addition, the study did not exclude residents who were receiving treatment with psychopharmacological medications such as antipsychotics or benzodiazepines during the time when the assessment was completed. This is noteworthy because such treatment potentially confounds the observed symptom pattern of delirium, particularly because antipsychotics are sometimes prescribed for the treatment of delirium (Duppils & Wikblad, 2000; Kirino, 2015). Also, our findings should be interpreted with consideration that the overall reliability and validity of the 10 items studied herein remain uncertain because this study pools items from MDS cognitive patterns and communication patterns.…”