Journal of General Internal Medicine

, Volume 24, Issue 7, pp 848–853

Pharmacological Management of Delirium in Hospitalized Adults – A Systematic Evidence Review

Authors

  • Noll Campbell
    • Department of PharmacyWishard Health Services
    • Indiana University Center for Aging Research
    • Regenstrief Institute, Inc.
    • Department of MedicineIndiana University School of Medicine
  • Amir Ayub
    • Indiana University Center for Aging Research
    • Regenstrief Institute, Inc.
  • George C. Fox
    • Kent Institute of MedicineUniversity of Kent
  • Stephanie L. Munger
    • Indiana University Center for Aging Research
    • Regenstrief Institute, Inc.
  • Carol Ott
    • College of Pharmacy and Pharmaceutical SciencesPurdue University
  • Oscar Guzman
    • Department of PharmacyWishard Health Services
  • Mark Farber
    • Department of MedicineIndiana University School of Medicine
  • Adetayo Ademuyiwa
    • Indiana University-Purdue University at Indianapolis
  • Ranjeet Singh
    • Indiana University-Purdue University at Indianapolis
Original Article

DOI: 10.1007/s11606-009-0996-7

Cite this article as:
Campbell, N., Boustani, M.A., Ayub, A. et al. J GEN INTERN MED (2009) 24: 848. doi:10.1007/s11606-009-0996-7

Abstract

BACKGROUND AND OBJECTIVES

Despite the significant burden of delirium among hospitalized adults, there is no approved pharmacologic intervention for delirium. This systematic review evaluates the efficacy and safety of pharmacologic interventions targeting either prevention or management of delirium.

DATA SOURCES

We searched Medline, PubMed, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to October 2008. We included randomized, controlled trials comparing pharmacologic compounds either to each other or placebo. We excluded non-comparison trials, studies with patients aged < 18 years, a history of an Axis I psychiatric disorder, and patients with alcohol-related delirium.

REVIEW METHODS

Three reviewers independently extracted the data for participants, interventions and outcome measures, and critically appraised each study using the JADAD scale.

RESULTS

We identified 13 studies that met our inclusion criteria and evaluated 15 compounds: second-generation antipsychotics, first-generation antipsychotics, cholinergic enhancers, an antiepileptic agent, an inhaled anesthetic, injectable sedatives, and a benzodiazepine. Four trials evaluated delirium treatment and suggested no differences in efficacy or safety among the evaluated treatment methods (first and second generation antipsychotics). Neither cholinesterase inhibitors nor procholinergic drugs were effective in preventing delirium. Multiple studies, however, suggest either shorter severity and duration, or prevention of delirium with the use of haloperidol, risperidone, gabapentin, or a mixture of sedatives in patients undergoing elective or emergent surgical procedures.

CONCLUSION

The existing limited data indicates no superiority for second-generation antipsychotics over haloperidol in managing delirium. Although preliminary results suggest delirium prevention may be accomplished through various mechanisms, further studies are necessary to prove effectiveness.

Copyright information

© Society of General Internal Medicine 2009