Delirium
 · 2 min read
 · Clint Eastwould
Table of contents

Pharmacological Interventions for Delirium: Options and Side Effects

Introduction

Delirium is an acute, confusional state often characterized by fluctuations in attention and cognition, commonly triggered by underlying medical conditions, medications, or withdrawal from substances. Pharmacological intervention can play a crucial role in managing symptoms, particularly when non-pharmacological strategies are insufficient. This article delves into the most commonly utilized pharmacological treatments for delirium, along with their potential side effects.

Details

  • Antipsychotics

    • First-Generation Antipsychotics (e.g., Haloperidol)
      • Effective for managing severe agitation and psychotic symptoms in delirium.
      • Common side effects include:
        • Extrapyramidal symptoms (EPS) such as tremors, rigidity, and akathisia.
        • Sedation and somnolence.
        • QT prolongation potentially leading to arrhythmias.
    • Second-Generation Antipsychotics (e.g., Quetiapine, Olanzapine)
      • Preferred for delirium due to a lower incidence of EPS.
      • Side effects may involve:
        • Weight gain and metabolic syndrome.
        • Sedation or drowsiness.
        • Increased risk of stroke and mortality in elderly patients with dementia.

  • Benzodiazepines

    • Generally reserved for patients experiencing alcohol withdrawal or severe agitation.
    • Commonly used agents include Lorazepam and Diazepam.
    • Potential side effects include:
      • Sedation, which can worsen cognitive impairment.
      • Increased risk of falls, particularly in elderly populations.
      • Risk of dependence or withdrawal symptoms with prolonged use.

  • Cholinesterase Inhibitors (e.g., Donepezil)

    • Primarily for patients with pre-existing cognitive disorders, although data on efficacy in acute delirium is limited.
    • Possible side effects:
      • Gastrointestinal symptoms like nausea, vomiting, and diarrhea.
      • Bradycardia and other heart rhythm disturbances.
      • Increased risk of falls due to dizziness.

  • Netrin-1 Inhibitors

    • Emerging pharmacological interventions targeting neuroinflammation in delirium.
    • Side effects are currently under investigation; potential risks are still being evaluated.

  • Other Considerations

    • Dosing and Administration:
      • Initiating treatment with low doses is advisable to assess tolerance.
      • Regular monitoring for efficacy and adverse effects is essential in ongoing management.
    • Patient Populations:
      • Special considerations are warranted for elderly patients or those with comorbidities, who may have increased sensitivity to drugs and heightened risk for side effects.
    • Caution with Polypharmacy:
      • The risk of drug-drug interactions increases with multiple medications, necessitating careful review of all concurrent therapies.

Conclusion

Pharmacological interventions for treating delirium include antipsychotics, benzodiazepines, cholinesterase inhibitors, and emerging treatments such as Netrin-1 inhibitors. While these medications can be effective in managing symptoms, each comes with a range of potential side effects that must be carefully weighed against the benefits. Regular assessment and monitoring, especially in vulnerable populations like the elderly, are key to optimizing treatment outcomes and minimizing risks.