Pharmacological Options
Currently there are no medications with an FDA approved indication for the treatment of delirium.
The American Psychiatric Association and the Society of Critical Care Medicine clinical practice guidelines recommends the use of haloperidol for the treatment of delirium, though it is acknowledged that this is based on sparse outcomes data from non-randomized case series and anecdotal reports (i.e., level C data). Haloperidol is a dopamine receptor antagonist that works by inhibiting dopamine neurotransmission, with resultant improvement in the positive symptomatology (hallucinations, agitated and combative behavior, etc) and often results in a sedative effect.
(Jacobi J et al., 2002)
Typical Antipsychotics
Haloperidol IV 2.5-5mg Q6-8H
Atypical Antipsychotics
Quetiapine - 50mg Q12H (up to 200mg Q12H)
Evidence - Develin et al. 2010
Olanzapine – 5mg daily
Evidence - Skrobik et al. 2004
Risperidone – 0.5mg BID (starting dose)
Evidence - Han and Kim 2004
The American Psychiatric Association and the Society of Critical Care Medicine clinical practice guidelines recommends the use of haloperidol for the treatment of delirium, though it is acknowledged that this is based on sparse outcomes data from non-randomized case series and anecdotal reports (i.e., level C data). Haloperidol is a dopamine receptor antagonist that works by inhibiting dopamine neurotransmission, with resultant improvement in the positive symptomatology (hallucinations, agitated and combative behavior, etc) and often results in a sedative effect.
(Jacobi J et al., 2002)
Typical Antipsychotics
Haloperidol IV 2.5-5mg Q6-8H
Atypical Antipsychotics
Quetiapine - 50mg Q12H (up to 200mg Q12H)
Evidence - Develin et al. 2010
Olanzapine – 5mg daily
Evidence - Skrobik et al. 2004
Risperidone – 0.5mg BID (starting dose)
Evidence - Han and Kim 2004
References:
Jacobi J et al. The American Psychiatric Association and the Society of Critical Care Medicine clinical practice guidelines. Crit Care Med 2002; 30:119-141.
Devlin et al. 2010. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicentre, randomized, double-blind, placebo controlled study. Crit Care Med; 38(2)416-427.
Skrobik et al. 2004. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med; 30:444-449.
Han et al. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics; 45(4) 297-301.
Jacobi J et al. The American Psychiatric Association and the Society of Critical Care Medicine clinical practice guidelines. Crit Care Med 2002; 30:119-141.
Devlin et al. 2010. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicentre, randomized, double-blind, placebo controlled study. Crit Care Med; 38(2)416-427.
Skrobik et al. 2004. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med; 30:444-449.
Han et al. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics; 45(4) 297-301.