Which medications are used to treat delirium?

Updated: Apr 25, 2019
  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MPH, MHA; Chief Editor: Glen L Xiong, MD  more...
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Answer

Delirium that causes injury to the patient or others should be treated with medications. The most common medications used are antipsychotic medications. While this is a common and seemingly useful strategy, the literature is still mixed. A 2015 meta-analysis of 15 studies found that second-generation antipsychotics (SGAs) may treat delirium better than placebo, usual care, or haloperidol. [36]  A 2016 meta-analysis of 19 studies found that antipsychotic use was not associated with change in delirium duration, severity, or hospital or ICU length of stay. [37]

Benzodiazepines often are used for alcohol and benzodiazepine withdrawal states.

Since decreased anticholinergic activity may be associated with delirium, anticholinesterase inhibitors have been tried. Even though case reports showed evidence that cholinesterase inhibitors may play a role in the management of delirium, larger trials and systematic review did not support this use. [38]  A randomized, double-blinded, placebo-controlled, multicenter trial in intensive care unit patients showed rivastigmine did not decrease duration of delirium and increased mortality in these patients. In this trial, the study group had more sicker patients with emergency admissions to the ICU, and this trial had used IV haloperidol, lorazepam, or propofol, in addition to rivastigmine, which might also have contributed to the delirium and increased mortality. [39]  A review of 7 trials of anticholinesterase inhibitors found that in 5 of the studies there was no benefit from the medications in either the prevention or management of delirium. [40]

 

Recent clinical trials showed that the melatonin supplement and its receptor agonist ramelteon may be useful in the prevention and management of delirium. Melatonin levels were found to be altered in delirium subjects. [41] Melatonin is available over the counter in North America. Ramelteon has been approved by the FDA for the treatment of insomnia. [42]


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