Preventing Delirium with Medications?

Key Concept

Short answer:

No evidence to support the use of medication to prevent delirium in hospitalized patients.

Cholinesterase inhibitors

No evidence of effectiveness.


  • 3 trials – no evidence of effectiveness
  • Preplanned subgroup analysis of haloperidol – no evidence for effectiveness
  • One study of 400 patients treated with olanzapine showed slightly lower incidence of delirium (moderate quality evidence)


No evidence of effectiveness.


Controversial. Some consider antipsychotics on case-by-case basis.

It is important to note that typical and atypical antipsychotics carry a black-box warning due to an increased risk of cerebrovascular adverse events and mortality in persons with dementia.

Bottom line:

There are no medications that can be administered to prevent delirium, including antipsychotics.


Siddiqi N, et al. Cochrane Database Syst Rev. 2016;3:CD005563.

Tess AV, et al. Ann Intern Med. 2018;168(7):498–505.

2019 American Geriatrics Society Beers Criteria® Update Expert Panel. J Am Geriatr Soc. 2019; 67(4):674-694.