Melatonin and Melatonin Agonist for Delirium in the Elderly Patients

Chakraborti, Dwaipayan; Tampi, Deena J.; Tampi, Rajesh R.

doi:10.1177/1533317514539379

Cited by 37 publications

(23 citation statements)

References 55 publications

(81 reference statements)

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“…Currently, guidelines on melatonin supplementation dosage are limited. The exact dose of melatonin used in different clinical trials ranges from 0.5 mg to 10 mg daily 47 . In the present meta‐analysis, subgroup analyses indicated that a higher dose of melatonin (5 mg) might be more beneficial for the prevention of POD.…”

Section: Discussionmentioning

confidence: 68%

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

Han

Qin

et al. 2020

Journal of Pineal Research

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It remains unclear whether melatonin and its analogues prevent postoperative delirium (POD). Therefore, we conducted a systematic review and meta-analysis to evaluate the effect of melatonin and its analogues on POD prevention. PubMed, Cochrane Library, Web of Science, Embase and CINAHL databases were searched.Primary outcome was the incidence of POD. Six randomized controlled trials, 2 cohort studies and 1 case-control study were included in this meta-analysis. Results showed that melatonin and its analogue ramelteon decreased the incidence of POD in the entire adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval[CI] 0.24-0.84, P = .01). When administered at a higher dose (5 mg), melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI 0.20-0.52, P < .00001).Melatonin administered less than 5 elimination half-lives before the surgery significantly reduced the POD incidence (OR = 0.31, 95% CI 0.19-0.49, P < .00001).Current literature supports the effectiveness of melatonin and its analogue ramelteon in POD prevention. However, the present study was limited by the significant heterogeneity of the included studies. More studies are needed to ascertain the preventive effect of melatonin and its analogues on the incidence of delirium after cardiac and noncardiac surgeries. K E Y W O R D S melatonin, meta-analysis, postoperative delirium, ramelteon, systematic review How to cite this article: Han Y, Wu J, Qin Z, et al. Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta-analysis. J Pineal Res. 2020;68:e12644.

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Section: Discussionmentioning

confidence: 68%

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

Han

Qin

et al. 2020

Journal of Pineal Research

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“…In contrast to patients who are treated in curative intent and where the fast tapering and stopping of neuroleptics and benzodiazepines is of upmost importance once the symptoms are no longer severe, it may be appropriate to continue the medication specifically in patients in the last days of life and patients with structural brain lesions (i.e., metastases) and severe symptoms such as agitation. In major trial registries (i.e., clinicaltrials.gov), a number of trials assessing melatonin (68)(69)(70)(71)(72)(73) for the prophylaxis and treatment of delirium and have been registered and some are already recruiting (e.g., ClinicalTrials.gov Identifier: NCT02615340, NCT03013790, NCT02536417). Once data from these trials becomes available, these approaches may provide an interesting alternative to neuroleptics and benzodiazepines.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care?—a critical appraisal of recent randomized controlled trials

Gaertner¹,

Eychmueller

Leyhe

et al. 2019

Ann. Palliat. Med.

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Delirium is a frequent condition in patients in a palliative care situation and most often associated with substantial burden or even danger for the persons concerned as well as caregivers and healthcare-professionals. Despite the lack of randomized-controlled-trials (RCTs) benzodiazepines and neuroleptic agents are used extensively in palliative care for the pharmacological management of delirium. A focused review for RCTs assessing pharmacotherapy with benzodiazepines and neuroleptics for the treatment of delirium in patients treated in a palliative care or hospice setting published in 2017 was performed in PubMed. A narrative summary of the findings of the RCTs and practical recommendation are presented. Of 42 publications, two RCTs could be included. One trial assessed the use of lorazepam (in addition to haloperidol) in case of agitation, the other placebo or risperidone or haloperidol in delirious palliative care patients. Neither risperidone nor haloperidol were superior compared to placebo, but were associated with higher mortality and morbidity. Lorazepam (along with haloperidol) reduced agitation in patients with delirium compared to placebo (along with haloperidol), but was unable to reduce the severity and incidence of delirium. It is of importance to note that psychopharmacotherapy with antipsychotics is mainly indicated for the hyperactive form of delirium and psychotic symptoms (e.g., delusions or hallucinations) in the hyperand hypoactive delirium. Severe agitation and aggressivity can be an indication for neuroleptics, when nonpharmacological interventions fail, whereas the use of benzodiazepines has to be limited to critical situations where neuroleptics cannot be applied and cases of delirium due to alcohol withdrawal. Both substances can aggravate, precipitate or mask delirium, result adverse events with substantial distress or unfavorable survival outcomes for the patients. Thus, they should only be used in severely symptomatic patients and the duration of the medication has to be limited in time. When delirium symptoms decay the psychopharmacotherapy has to be tapered. More important than psychopharmacotherapy, the thorough investigation and treatment of potentially reversible causes of delirium (e.g., pharmacotherapy, infection) and the routine identification of patients at risk for delirium along with prophylactic measures are essential. The recently published landmarks RCTs provide moderate evidence to adopt recommendations from other medical specialties (i.e., intensive care, geriatrics) to the field of palliative care.

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“…[71415] In addition, it has been shown that melatonin is able to treat and prevent the ICU delirium. [1617]…”

Section: Discussionmentioning

confidence: 99%

Melatonin supplementation may improve the outcome of patients with hemorrhagic stroke in the intensive care unit

et al. 2017

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Objective:Although mechanical ventilation is frequently a life-saving therapy, its use can result in unwanted side effects. It has been well documented that the choice of sedating agent may influence the duration of mechanical ventilation. Melatonin is a sedative and analgesic agent without any respiratory depressant effect which makes it an attractive adjuvant for sedation in the intubated patients. The aim of this study is to evaluate the effect of melatonin on the duration of mechanical ventilation in patients with hemorrhagic stroke.Methods:Forty adult intubated patients with hemorrhagic stroke, who were admitted to the Intensive Care Unit (ICU) within 24 h of onset, were enrolled in this randomized double-blind study. Subjects in the melatonin group received 30 mg of melatonin every night throughout the nasogastric tube. Length of ICU stay, mortality, and duration of mechanical ventilation were recorded for all patients.Findings:The duration of mechanical ventilation and length of ICU stay were shorter in patients who received melatonin in comparison with the control group, and this difference was statistically significant for the length of ICU stay and marginally significant for the duration of mechanical ventilation. Although not statistically significant, the mortality rate of the control group was 30%, almost double that of the study group (15%).Conclusion:Melatonin possesses hypnotic, analgesic, anti-inflammatory, and anti-oxidative properties that distinguish it as an attractive adjuvant in patients under mechanical ventilation. In conclusion, the administration of melatonin may facilitate the weaning process through decreasing the consumption of sedatives with respiratory depressant properties as well as preventing ventilator-associated lung injury.

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Melatonin and Melatonin Agonist for Delirium in the Elderly Patients

Cited by 37 publications

References 55 publications

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care?—a critical appraisal of recent randomized controlled trials

Melatonin supplementation may improve the outcome of patients with hemorrhagic stroke in the intensive care unit

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