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  • Haloperidol

    High-potency antipsychotic medications, such as haloperidol, are the pharmacological treatment of choice for delirium.

    • Haloperidol 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.

  • Droperidol

    • Droperidol may 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

    • Risperidone, 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 available.

References

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