Journal of General Internal Medicine

, Volume 24, Issue 7, pp 848–853 | Cite as

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

  • Noll Campbell
  • Malaz A. BoustaniEmail author
  • Amir Ayub
  • George C. Fox
  • Stephanie L. Munger
  • Carol Ott
  • Oscar Guzman
  • Mark Farber
  • Adetayo Ademuyiwa
  • Ranjeet Singh
Original Article



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.


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.


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


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.


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.


Haloperidol Dexmedetomidine Citicoline Quazepam Delirium Prevention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Noll Campbell
    • 1
  • Malaz A. Boustani
    • 2
    • 3
    • 4
    Email author
  • Amir Ayub
    • 2
    • 3
  • George C. Fox
    • 5
  • Stephanie L. Munger
    • 2
    • 3
  • Carol Ott
    • 6
  • Oscar Guzman
    • 1
  • Mark Farber
    • 4
  • Adetayo Ademuyiwa
    • 7
  • Ranjeet Singh
    • 7
  1. 1.Department of PharmacyWishard Health ServicesIndianapolisUSA
  2. 2.Indiana University Center for Aging ResearchIndianapolisUSA
  3. 3.Regenstrief Institute, Inc.IndianapolisUSA
  4. 4.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  5. 5.Kent Institute of MedicineUniversity of KentCanterburyUK
  6. 6.College of Pharmacy and Pharmaceutical SciencesPurdue UniversityWest LafayetteUSA
  7. 7.Indiana University-Purdue University at IndianapolisIndianapolisUSA

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