Pharmacologic Interventions

When to consider pharmacologic interventions?

  • May consider if:
    • Nonpharmacologic interventions unsuccessful
    • Patient is a danger to themselves or others

Which option to choose?

  • Most recommendations are an extrapolation of outpatient data and expert consensus
  • No “best” medication option

Therapeutic goal

Calm without inducing sleep

When using pharmacologic interventions for delirium:

  • Oral Regimen Preferred

  • Start Low and Go Slow

  • Allow time for therapeutic effect


  • No FDA-approved pharmacologic intervention
  • Commonly used agents
    • First-generation antipsychotics (FGAs)
    • Second-generation antipsychotics (SGAs)
    • Benzodiazepines
  • Antipsychotics and benzodiazepines
    potentially inappropriate by the Beer’s criteria


American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227–2246