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

Journal of General Internal Medicine volume 24, pages 848–853 (2009)Cite this article

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.

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Acknowledgements

Supported by Grant (K23 AG 26770–01) from the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the National Institute on Aging.

Conflict(s) of interest

None disclosed.

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Authors and Affiliations

  1. Department of Pharmacy, Wishard Health Services, Indianapolis, IN, USA

    Noll Campbell PharmD, BCPP, CGP, FASCP & Oscar Guzman PharmD, BCPS

  2. Indiana University Center for Aging Research, Indianapolis, IN, USA

    Malaz A. Boustani MD, MPH, Amir Ayub MD & Stephanie L. Munger BS

  3. Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN, 46202–3012, USA

    Malaz A. Boustani MD, MPH, Amir Ayub MD & Stephanie L. Munger BS

  4. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Malaz A. Boustani MD, MPH & Mark Farber MD

  5. Kent Institute of Medicine, University of Kent, Canterbury, UK

    George C. Fox MRCPsych, Mmedsci

  6. College of Pharmacy and Pharmaceutical Sciences, Purdue University, West Lafayette, IN, USA

    Carol Ott PharmD, BCPP

  7. Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA

    Adetayo Ademuyiwa MD & Ranjeet Singh MD

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  1. Noll Campbell PharmD, BCPP, CGP, FASCP
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  2. Malaz A. Boustani MD, MPH
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  6. Carol Ott PharmD, BCPP
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  7. Oscar Guzman PharmD, BCPS
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Corresponding author

Correspondence to Malaz A. Boustani MD, MPH.

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Campbell, N., Boustani, M.A., Ayub, A. et al. Pharmacological Management of Delirium in Hospitalized Adults – A Systematic Evidence Review. J GEN INTERN MED 24, 848–853 (2009). https://doi.org/10.1007/s11606-009-0996-7

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  • DOI: https://doi.org/10.1007/s11606-009-0996-7

Keywords

  • Haloperidol
  • Dexmedetomidine
  • Citicoline
  • Quazepam
  • Delirium Prevention