From the Research
Quetiapine should not be the first-line treatment for psychosis in Lewy body dementia (LBD) due to the availability of safer alternatives like pimavanserin, which has shown promise in reducing distressful hallucinations, delusions, and paranoia in patients with LBD. When considering the use of quetiapine, it's essential to weigh the potential benefits against the risks, as LBD patients are highly sensitive to antipsychotics and may experience severe neuroleptic sensitivity reactions, including worsened parkinsonism, sedation, confusion, and potentially life-threatening complications 1.
Key Considerations
- Non-pharmacological approaches should be attempted first to manage psychosis and agitation in LBD patients.
- If medication is necessary, pimavanserin may be a safer alternative to quetiapine, as it has shown efficacy in reducing psychosis in LBD patients with fewer side effects 1.
- Quetiapine, if used, should be started at very low doses (12.5-25mg at bedtime) and gradually titrated up as needed, rarely exceeding 100mg daily.
- Regular monitoring for side effects is crucial, and the medication should be discontinued if adverse reactions occur or if ineffective after an adequate trial.
Evidence Summary
The most recent and highest-quality study on this topic is a 2023 case series that suggests pimavanserin is tolerable and effective in reducing psychosis in LBD patients 1. While quetiapine has been used in the past to manage psychosis in LBD, its use is associated with significant risks, and safer alternatives like pimavanserin should be considered first. Other studies have highlighted the importance of non-pharmacological approaches and the potential benefits of cholinesterase inhibitors like donepezil in managing cognitive and behavioral symptoms in LBD patients 2, 3. However, when it comes to managing psychosis, pimavanserin appears to be a safer and more effective option than quetiapine.