Antipsychotics for delirium

Lonergan, Edmund; Britton, AM; Luxenberg, Jay S.; Wyller, Torgeir Bruun

doi:10.1002/14651858.cd005594

Cited by 41 publications

(77 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the results of this study are hypothesis generating and notable as it was the first study to demonstrate decreased mortality with haloperidol use. There is great need for more robust research in the area of delirium, as a recent Cochrane systematic review identified only three un-confounded, randomized trials of antipsychotics in delirium [16].…”

Section: Discussionmentioning

confidence: 99%

“…Atypical antipsychotics, risperidone, and olanzapine, have shown equal efficacy with similar incidence of adverse effects as compared to low-dose haloperidol [55,56]. Given the growing body of evidence supporting their use, atypical antipsychotics may be considered first-line in treatment of delirium for patients refractory to low-dose haloperidol or who are at risk of adverse effects from haloperidol (i.e., prolonged QT interval or EPS at baseline, cardiac abnormalities, on concomitant QT-prolonging drugs) [16]. However, one limitation of atypical antipsychotics is the lack of nondepot parenteral dosage forms; oral dosage forms may be unfavorable in patients with compromised GI physiology and who require rapid control of acute delirium.…”

Section: Discussionmentioning

confidence: 99%

“…If these are insufficient, then pharmacologic treatment is warranted. Haloperidol is a preferred pharmacotherapeutic agent for treating delirium because it targets the pathogenesis of delirium, has a rapid onset of action, no active metabolites, does not require dosage adjustment in organ dysfunction, and has minimal sedative, hypotensive, and autonomic effects [14][15][16][17][18][19]. Haloperidol can be given orally/enterally (tablet, liquid), intramuscularly, and intravenously.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Haloperidol Dosing Strategies in the Treatment of Delirium in the Critically-Ill

et al. 2011

View full text Add to dashboard Cite

Delirium is the most common mental disturbance in critically-ill patients and results in significant morbidity and mortality. Haloperidol is a preferred agent for the treatment of delirium in this population because of its rapid onset of action and lack of hemodynamic effects. Despite its widespread use in the critical care setting, most of the relevant data are obtained from case series or extrapolated from non-critically-ill populations. This review provides an overview of haloperidol pharmacokinetics and a comprehensive summary of the evidence for various haloperidol dosing regimens in the treatment of delirium in critically-ill patients. A comprehensive literature search was conducted in Medline, Embase, and International Pharmaceutical Abstracts with "haloperidol", "delirium", "agitation", "critically-ill", and "intensive care" as keywords. Studies involving haloperidol for delirium prophylaxis, non-critical care settings, and terminally-ill subjects were excluded. Eleven studies were identified: four with intermittent IV haloperidol, four with continuous IV infusion haloperidol, two with oral/enteral haloperidol, and one with IM haloperidol. All of the case reports, case series, and descriptive studies have shown a benefit with haloperidol, but publication bias is likely present. Only three studies were controlled studies, but all had small sample sizes and methodological flaws. Randomized, double-blind, active-comparator trials of haloperidol with allocation concealment are needed. Subsequent research should focus on using validated delirium screening and assessment scales for more objective identification and measurement of delirium outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Haloperidol Dosing Strategies in the Treatment of Delirium in the Critically-Ill

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Haloperidol was evaluated as PIM only in the second round taking into account its still leading role in the treatment of delirium, topping atypical antipsychotics in clinical effi cacy and safety profi le [35].…”

Section: Psychotropic Drugsmentioning

confidence: 99%

Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list

Mann

Böhmdorfer

Frühwald

et al. 2011

Wien Klin Wochenschr

View full text Add to dashboard Cite

show abstract

“…However, in a recent Cochrane database review studying the efficacy and incidence of adverse effects among haloperidol, risperidone, olanzapine, and quetiapine, essentially no differences in efficacy in the management of delirium in hospitalized patients were found. 55 Despite the lack of strong evidence backing its recommendation, haloperidol is still the most widely used neuroleptic agent in the ICU. 56 Haloperidol must be used with caution because it has a variety of adverse effects, including dystonias, neuroleptic malignant syndrome, extrapyramidal effects, and the most worrisome torsades de pointes.…”

Section: Haloperidolmentioning

confidence: 99%