Atypical Antipsychotics versus Haloperidol for Treatment of Delirium in Acutely Ill Patients

ArticleinPharmacotherapy 27(4):588-94 · May 2007with59 Reads
DOI: 10.1592/phco.27.4.588 · Source: PubMed
Abstract
Delirium is common in acutely ill patients and can result in substantial morbidity if left untreated. Atypical antipsychotics have been postulated to be safer and more effective than haloperidol for treatment of this condition. To evaluate the role of atypical antipsychotics versus haloperidol for treatment of delirium in hospitalized acutely ill adults, we searched MEDLINE (1977-September 2006) and International Pharmaceutical Abstracts (1997-September 2006) for English-language publications of clinical trials that compared atypical antipsychotics and haloperidol. Four comparative studies were identified: one double-blind, randomized study (risperidone vs haloperidol), one single-blind, randomized study (olanzapine vs haloperidol), and two retrospective studies (olanzapine vs haloperidol and quetiapine vs haloperidol). These studies demonstrated that atypical antipsychotics are as efficacious as haloperidol. In addition, they appear to be associated with a lower frequency of extrapyramidal effects, and thus are safer than haloperidol. However, these conclusions are based on a limited number of studies; larger comparative trials are needed to elucidate the role of atypical antipsychotics for treating delirium in this population.
    • "The use of antipsychotic medications, such as haloperidol is controversial and further research is needed to determine the safety and efficacy of using antipsychotics in general to treat delirium in ICU patients [28] . Based on limited studies, atypical antipsychotics (olanzapine, quetiapine, ziprasidone) are favored over haloperidol (although some consider it to be the drug of choice) because of lower rate of extrapyramidal symptoms and orthostatic hypotension [29]. It must, however, be cautioned that dopamine receptor antagonists may interfere with recovery after brain injury [30,31]. "
    [Show abstract] [Hide abstract] ABSTRACT: Altered mental status is a common pathological entity in critically ill patients and particularly in those with preexisting cerebral injury. In the neurological critical care unit, the prevalence of altered mental status is especially high because of the inherent nervous system disease of these patients. Altered mental status can be crudely divided into encephalopathy and delirium. Although often used interchangeably, the 2 pathological entities have subtle differences in etiology and presentation. This is a review of delirium and encephalopathy in the neurological critical care unit. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Jul 2015
    • "However, based on our study these instructions are not followed as the median duration of risperidone use was 179 days corresponding to 25.6 weeks. Although atypical antipsychotics might be as effective as haloperidol in the acute treatment of delirium, haloperidol has been considered as a standard treatment option for delirium (Lonergan et al., 2007; Rea et al., 2007). Thus, shorter duration of haloperidol use compared with risperidone might be explained by more frequent use of haloperidol in the treatment of delirium. "
    [Show abstract] [Hide abstract] ABSTRACT: Antipsychotics are recommended only for short-term treatment of severe behavioral and psychological symptoms of dementia. Our objective was to study the duration of antipsychotic use and factors associated with long-term use (365 days or over) among community-dwelling persons with Alzheimer׳s disease (AD) during a 7-year follow-up. This was a nationwide register-based cohort study including all community-dwelling residents in Finland diagnosed with AD in 2005 (n=7217). The follow-up for antipsychotic use started 3 years before the diagnosis of AD and we applied a 7-year washout period to ascertain truly incident antipsychotic use. Follow-up ended on institutionalization, death or at the end of study period (December 31, 2009). Duration of antipsychotic use was modeled from individual purchase histories recorded in the Finnish Prescription Register. During the 7-year follow-up, 34% (2287/6740) of persons initiated antipsychotic use. Median duration of the first antipsychotic use period was 219 (interquartile range 85-583) days. Of those who discontinued antipsychotic use (n=1303), 44% restarted use later. Among users with at least one year of follow-up time after initiating antipsychotic use, prevalence of long-term use was 57% (893/1563). Long-term use was associated with initiation of use after AD diagnosis and choice of antipsychotic. Duration of use was more likely to be shorter among haloperidol users and longer among quetiapine users compared with risperidone users. In conclusion, long-term use of antipsychotics is frequent among community-dwelling persons with AD. Duration of use is not in line with the guidelines recommending time-limited use of antipsychotics. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.
    Full-text · Article · Jul 2015
    • "The different action of atypical APs has been reported to be related to a safer profile (e.g., little or no propensity to cause EPS, reduced capacity to elevate prolactin levels, and reduction of negative symptoms of schizophrenia) and better tolerability than typical APS, although controversies still exist about this issue [73]. Data regarding the use of APs in delirium indicated no difference between haloperidol in low-dosage and atypical APs (e.g., olanzapine and risperidone) both in terms of efficacy and frequency of adverse drug effects [74, 75], with haloperidol considered as a first-line drug in cancer patients [32] . Data are also quite controversial about the dosages of APs, however. "
    [Show abstract] [Hide abstract] ABSTRACT: Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care.
    Full-text · Article · Mar 2015
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