Management of delirium comprises identification and wherever possible treatment of possible underlying cause(s):
- Organ failure
- Fluid or electrolyte disturbance
• Delirium is commonly caused by medicines and the patient’s current medicines should be reviewed before
pharmacological management is initiated.
• When treatment of the underlying cause(s) of delirium is not possible or unsuccessful, pharmacological management is necessary.
Causal treatment may not be indicated in patients with limited prognosis and pharmacological symptomatic therapy has to be initiated without delay.
is considered as first choice therapy in the management of delirium during the terminal phases of disease.
- It has been shown to be effective in the management of both hyperactive and hypoactive delirium in adult patients during the terminal phases of disease. However, the amount of evidence is limited.
- In two controlled studies haloperidol
was as effective as clopromazine
, but significantly more effective than lorazepam
- Considering the lack of evidence from clinical trials, the recommendation for haloperidol
is based on clinical expertise. Expert opinion strongly supports the use of haloperidol
for treatment of delirium in adults.
Injection: 5 mg in 1‐ml ampoule.
Oral liquid: 2 mg/ml.
Solid oral dosage form: 0.5 mg; 2mg; 5 mg
Additional supporting information for this drug:
• Oral bioavailability of 60-70%
• Onset of action 10-15 minutes if given SC; >1 hour if given orally.
• The time to peak plasma concentration is 10-20 minutes subcutaneously and 30-40 minutes if given orally.
• Duration of action up to 24 hours, sometimes longer.
• It carries the risk of extrapyramidal side-effects. When compared with chlorpromazine
has less effect on the cardiovascular system.
• It does not have any antimuscarinic properties
• It is widely available and at low cost
Despite the absence of good quality clinical trials, haloperidol
is widely used in the management of delirium in palliative care.
Adapted from Radbruch L et al. Essential medicines in palliative care - An application for the 19th WHO Expert committee on the selection and use of essential medicines. Kindle Edition, 135 pages. Published June 5th 2013 by IAHPC Press. Available at https://www.amazon.com/Essential-Medicines-Palliative-Care-Application-ebook/dp/B00D7S2D0C