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High-potency antipsychotic medications, such as haloperidol,
are the pharmacological treatment of choice for delirium.
may be administered orally, intramuscularly, or intravenously.
Initial dosages of haloperidol are in the
range of 1 to 2 mg every 2 to 4 hours, with lower starting dosages
for elderly patients (e.g., 0.25 to 0.50 mg every 4 hours).
Continuous intravenous infusion of haloperidol
may be considered for severely ill patients with refractory symptoms
requiring multiple bolus doses. With ECG monitoring, intravenous
haloperidol can be initiated with a bolus dose of up to 10 mg followed
by infusion of up to 5 to 10 mg/hour.
When using haloperidol to treat delirium,
monitor ECG. For QTc intervals greater than 450 msec or greater
than 25% over baseline, consider cardiology consultation
and antipsychotic medication discontinuation.
be considered for acute agitation because of its more rapid onset
of action, greater sedative properties, and shorter half-life.
Droperidol may be administered either alone
or followed by haloperidol.
As with haloperidol, monitor ECG. Droperidol
use has been associated with QTc prolongation, torsades de pointes,
and sudden death.
Newer antipsychotic medications
olanzapine, and quetiapine have been increasingly used to treat
delirium, in part because of their more tolerable side effect profile.
Randomized, double-blind, placebo-controlled
trials of these medications in patients with delirium are not yet