From the Guidelines
Iloperidone is not recommended for treating dementia-related psychosis in elderly patients. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia 1 suggests that the benefits of antipsychotic medications, including iloperidone, are at best small, and are associated with clinically significant adverse effects, including mortality. Additionally, the World Health Organization's evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries recommend that haloperidol and atypical antipsychotics, including iloperidone, should not be used as first-line management for behavioral and psychological symptoms of dementia 1.
The use of iloperidone in elderly patients with dementia-related psychosis is also associated with significant side effects, including orthostatic hypotension, QT prolongation, and sedation, which may be particularly problematic in this population. The FDA has issued a black box warning against using atypical antipsychotics, including iloperidone, in elderly patients with dementia-related psychosis due to an increased risk of mortality. Studies have shown that elderly patients with dementia who are treated with antipsychotics have a 1.6 to 1.7 times higher risk of death compared to those receiving placebo.
For dementia-related psychosis, non-pharmacological approaches should be tried first, such as:
- Behavioral interventions
- Environmental modifications
- Caregiver education If medication is absolutely necessary, it should be prescribed at the lowest effective dose for the shortest duration possible, with close monitoring, and only after a thorough discussion of risks and benefits with the patient and/or their caregivers.
From the FDA Drug Label
Iloperidone is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning, Warnings and Precautions (5.2)]. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death Iloperidone tablets is not approved for the treatment of patients with dementia-related psychosis . [see Boxed Warning, Warnings and Precautions (5.1)].
Iloperidone is not suitable for treating dementia-related psychosis, as it is not approved for this indication and may increase the risk of death in elderly patients with dementia-related psychosis 2.
From the Research
Iloperidone for Dementia-Related Psychosis
- There is no direct evidence in the provided studies to support the use of Iloperidone for dementia-related psychosis.
- However, the studies discuss the use of other atypical antipsychotics, such as quetiapine, risperidone, olanzapine, aripiprazole, and brexpiprazole, for the treatment of dementia-related psychosis 3, 4, 5, 6, 7.
- These studies suggest that atypical antipsychotics may be effective in managing dementia-related psychosis, but they are also associated with increased risks of mortality, cerebrovascular events, and other adverse effects 5, 6, 7.
- The use of atypical antipsychotics for dementia-related psychosis should be individualized and carefully monitored due to the potential risks and benefits 6, 7.
- Further research is needed to develop more effective and safer treatments for dementia-related psychosis, as the current options have limited efficacy and significant risks 3, 5.