Preventing Delirium with Medications?
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Key Concept
Short answer:
No evidence to support the use of medication to prevent delirium in hospitalized patients.
Cholinesterase inhibitors
No evidence of effectiveness.
Antipsychotics
- 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)
Melatonin
No evidence of effectiveness.
Antipsychotics
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.
References
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.