From the Guidelines
Brexpiprazole has not been studied in the treatment of delirium, and its use for this condition would be considered off-label. The current evidence base for managing delirium does not include brexpiprazole, as noted in the clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU 1. While the guidelines discuss the use of antipsychotics like haloperidol and atypical antipsychotics for delirium, they emphasize the potential undesirable effects of these medications and recommend against their routine use, suggesting that benefits may be outweighed by risks for most critically ill adults with delirium 1.
Key points to consider in the context of delirium management include:
- The lack of specific studies on brexpiprazole for delirium treatment
- The conditional recommendation against the routine use of antipsychotics, including atypical ones, due to potential morbidity and financial costs 1
- The importance of considering the pharmacological profile of any medication, including brexpiprazole, which acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors with antagonist activity at 5-HT2A receptors, potentially offering a favorable side effect profile
- The preference for medications with established evidence in delirium management when pharmacological intervention is deemed necessary
Given the emphasis on minimizing unnecessary antipsychotic use in the ICU due to potential harms and the lack of direct evidence supporting brexpiprazole's use in delirium, the most prudent approach is to prioritize other, more studied interventions for delirium management. This decision aligns with guidelines that suggest a cautious approach to antipsychotic use in critically ill patients with delirium, highlighting the need for careful consideration of the potential benefits and risks 1.
From the Research
Studies on Brexpiprazole in Delirium Treatment
- There are no direct studies on the use of brexpipiazole in the treatment of delirium found in the provided evidence 2, 3, 4, 5, 6.
Atypical Antipsychotics in Delirium Treatment
- Atypical antipsychotics have been found to be effective in the treatment of delirium, with studies showing improvement in delirium symptomatology after administration 2.
- However, the evidence is limited and inconclusive, with no double-blind, placebo-controlled studies assessing the efficacy and safety of these agents in delirium 2.
- Other atypical antipsychotics, such as aripiprazole, have been studied in the treatment of delirium, with some evidence suggesting they may be effective and safe, but more research is needed 3.
- Brexpiprazole has been studied in the treatment of agitation in Alzheimer's dementia, but not specifically in delirium 4.