Newer atypical antipsychotics may be effective for the treatment of older adult bipolar disorder (OABD), however randomized controlled trials (RCTs) are urgently needed to confirm efficacy and tolerability in this patient population, according to a review published in the journal Drugs & Aging.

While pharmacologic agents such as lithium and valproic acid have been shown to provide significant antimanic effects in older adults with bipolar disorder, an increase in the use of atypical antipsychotics in the general adult bipolar population prompted researchers to investigate the efficacy and tolerability of these agents in OABD. The authors searched various databases to identify RCTs that compared newer atypical antipsychotics (including brexpiprazolecariprazine, lurasidone, iloperidone, asenapine, paliperidone, and aripiprazole) with placebo or comparator in older bipolar patients (>65 years), however no RCTs could be found using these criteria.

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After modifying the age cutoff to ≥55 years and expanding the search to include post-hoc studies, lurasidone was found to be reasonably safe and effective in the acute and maintenance treatment of OABD. Findings from open-label studies also showed that oral asenapine and aripiprazole given as add-on therapy improved symptoms of depression and mania in OABD; both drugs were adequately tolerated as well.

With regard to the use of brexpiprazole, cariprazine, iloperidone, or paliperidone, there were no trials available that evaluated older patients with bipolar disorder.

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