A1 - Retrospective and observational study(1616 Boettger S, Jenewein J, Breitbart W. Delirium management in patients with cancer: dosing of antipsychotics in the delirium subtypes and response to psychopharmacological management. Ger J Psychiatr. 2014;17(1):10-8. doi: 10.5167/uzh-107992
https://doi.org/10.5167/uzh-107992...
) / Level of evidence 4 |
Pharmacological management of hypoactive and hyperactive delirium/111 patients in a Cancer Hospital attended in the Psychiatric Unit (49 patients with hypoactive delirium and 62 with hyperactive delirium). |
Doses from four different antipsychotic drugs were used to treat delirium; considering hyperactive delirium as compared to hypoactive delirium, haloperidol was prescribed four times more, olanzapine and risperidone twice as much; while the dose of aripiprazole was the same for both. |
Patients with hyperactive delirium needed bigger doses for the control of their condition. |
The antipsychotic pharmacological management was not selected randomly but based on the preferences of the physicians responsible for the treatment. The criteria for the choice of the medications were not made clear. |
A2 - Observational and retrospective study(1717 Hey J, Hosker C, Ward J, Kite S, Speechley H. Delirium in palliative care: detection, documentation and management in three settings. Palliat Support Care. 2015;13(6):1541-5. doi: 10.1017/S1478951513000813
https://doi.org/10.1017/S147895151300081...
) / Level of evidence 3 |
Pharmacological management of delirium, compared between one hospital and two hospices/319 records: 166 patients in a hospital and 153 in the hospices. |
In the hospices, the records of management had a median of 69.4%. Midazolam was the most used medication (up to 66.7% of prescriptions), followed by a combination of midazolam and haloperidol (up to 26.6% of prescriptions), and haloperidol (up to 20% of prescriptions). |
The diagnosis of delirium was registered in 8.4% of records; in the others, there were descriptions of signs and symptoms of delirium.
In 56.3% of the hospital records, there was a description of the pharmacological management, but the medications used were not listed. |
Patients were not classified according to the type of delirium. The drugs used in the hospital unit were not described. |
A3 - Retrospective and observational study(1818 Cruz M, Ransing V, Yennu S, Wu J, Lju D, Reddy A, et al. The Frequency, Characteristics, and outcomes among cancer patients with delirium admitted to an acute palliative care unit. Oncologist. 2015;20(12):1425-31. doi: 10.1634/theoncologist.2015-0115
https://doi.org/10.1634/theoncologist.20...
) / Level of evidence 3 |
Pharmacological and non-pharmacological management of mixed, hypoactive, and hyperactive delirium/552 patients in a Hospital Unit for Acute Palliative Care, classified as having mixed state (45%), hypoactive (30%), and hyperactive (25%) delirium. |
Haloperidol was used in 66% of cases, followed by chlorpromazine in 3% of cases, and for an association of olanzapine and lorazepam in 31% of patients. Actions were carried out to educate the family about delirium, about the presence of a caregiver with the patient, minimal stimulations and interventions from the nursing team, and techniques and guidance for non-pharmacological management. |
Haloperidol was the most used drug for the management of all types of delirium; the nonpharmacological management included educational actions. |
The doses of the drugs used were not described.
The authors mentioned non-pharmacological management actions but did not make clear what was the techniques used for advice. |
A4 - Retrospective and observational study(1919 Shin SH, Hui D, Chisholm G, Kang JH, Allo J, Williams J, et al. Frequency and outcome of neuroleptic rotation in the management of delirium in patients with advanced cancer. Cancer Res Treat. 2015;47(3):399-405. doi: 10.4143/crt.2013.229
https://doi.org/10.4143/crt.2013.229...
) / Level of evidence 3 |
Pharmacological management delirium/167 patients in a Hospital Unit for Acute Palliative Care, classified as having mixed state and hyperactive (53%), and hypoactive (47%) delirium. |
77% of the patients used, exclusively, haloperidol in starting doses of 5 mg; in 23% of cases, it was necessary to introduce a second neuroleptic drug, suspending the haloperidol, due to either failure in the treatment or adverse effects. A second neuroleptic drug was used in association with the previous haloperidol regime adopted in only 15% of patients. |
Haloperidol was the most used drug to deal with delirium; in 77% of cases, there was no need to change for another neuroleptic drug. |
This study did not evaluate separately the efficiency of the treatment for patients with mixed state and hyperactive delirium |
A5 - Retrospective and observational study(2020 Al-Shahri MZ, Sroor MY, Ghareeb WA, Aboulela EN, Edesa W. Using neuroleptics to treat delirium in dying cancer patients at a cancer center in Saudi Arabia. J Pain Palliat Care Pharmacother. 2015;29(4):365-9. doi: 10.3109/15360288.2015.1101638
https://doi.org/10.3109/15360288.2015.11...
) / Level of evidence 3 |
Pharmacological management of delirium/271 records of patients in a Palliative Care Hospital Unit. |
Patients were treated with drugs that were prescribed periodically with standardized inte4rvals: 89.3% haloperidol; 2.4% Levomepromazine; and 8.3% used a combination of them. In association to the periodical prescriptions, 93.8% of patients needed additional haloperidol doses, while 1.4% required additional levomepromazine doses. |
Haloperidol was the most used neuroleptic for the treatment of delirium, followed by levomepromazine. |
Patients were not classified according to the type of delirium. |
A6 - Cross sectional, observational, and multi-centric study(2121 Tanimukai H, Tsujimoto H, Matsuda Y, Tokoro A, Kanemura S, Watanabe M, et al. Novel therapeutic strategies for delirium in patients with cancer: a preliminary study. Am J Hosp Palliat Care. 2016;33(5):456-2. doi: 10.1177/1049909114565019
https://doi.org/10.1177/1049909114565019...
) / Level of evidence 3 |
Pharmacological management of delirium/27 patients in 11 general hospitals, including three Palliative Care units. |
Patients were treated with an association of drugs divided in two groups: 48.1% were treated with an association of haloperidol and risperidone (long-acting psychotic drugs) and 51.9% were treated with olanzapine and quetiapine (antipsychotic drugs with a short duration). |
It was found that comparing the two antipsychotic associations, the prolonged action ones and the short-term ones, resulted in a similar efficiency to treat delirium. |
The study was not randomized or controlled. The size of the sample was small, and the types of delirium were not separated (hyperactive, hypoactive, mixed state). |
A7 - Randomized, controlled, double-blind clinical trial(2222 Hui D, Frisbee-Hume S, Wilson A, Dibaj SS, Nguyen T, De La Cruz M, et al. Effect of lorazepam with haloperidol vs haloperidol alone on agitated delirium in patients with advanced cancer receiving palliative care: a randomized clinical trial. JAMA. 2017;318(11):1047-56. doi: 10.1001/jama.2017.11468
https://doi.org/10.1001/jama.2017.11468...
) / Evidence level 2 |
Pharmacological management of hyperactive or mixed state delirium/52 patients in a Unite for Acute Palliative Care |
Patients of the intervention group (lorazepam and haloperidol), when compared to the control group (placebo and haloperidol) presented a significant diminution in their agitation and needed lower doses of neuroleptic drugs for recovery in their first 8 hours of treatment. |
After the neuroleptic drugs were used, a significant reduction was found in the agitation of the patient from the intervention group, who felt more comfortable. |
Nothing to report. |
A8 - Retrospective and observational study(2323 Hasuo H, Kanbara K, Fujii R, Uchitani K, Sakuma H, Fukunaga M. Factors associated with the effectiveness of intravenous administration of chlorpromazine for delirium in patients with terminal cancer. J Palliat Med. 2018;21(9):1257-64. doi: 10.1089/jpm.2017.0669
https://doi.org/10.1089/jpm.2017.0669...
) / Level of evidence 3 |
Pharmacological management of mixed state, hyperactive, and hypoactive delirium/97 patients, in a terminal stage of cancer, hospitalized in the Palliative Care Department of a University Hospital. |
Most patients (67%) presented with hyperactive delirium. All were medicated with chlorpromazine, and the dosage was increased in the night shift. There was a significant improvement after the third day of treatment among patients with a mean survival rate of 21 days. |
A high incidence of hyperactive delirium was found in the studied group. The administration of chlorpromazine was considered to be more effective for patients whose survival rate was longer than two weeks. |
There was no control group. |
A9 - Retrospective and observational study(2424 Kwon JH, Kim MJ, Bruera S, Parque M, Bruera E, Hui D. Off-label medication use in the inpatient palliative care unit. J Pain Symptom Manage. 2017;54(1):46-54. doi: 10.1016/j.jpainsymman.2017.03.014
https://doi.org/10.1016/j.jpainsymman.20...
) / Level of evidence 3 |
Pharmacological management of delirium/744 prescriptions associated to 201 patients in a Unit for Acute Palliative Care in a Cancer Hospital. |
To treat the delirium, 62% of prescriptions corresponded to the administration of haloperidol, 31% to that of chlorpromazine, 4.5% of lorazepam, and 2.5% of midazolam. |
Haloperidol was the most prescribed drug to manage delirium. It was also indicated to control anxiety, insomnia, nausea, and vomit. |
Patients were not classified according to the type of delirium. |
A10 - Observational and multi-centric study(2525 Okuyama T, Yoshiuchi K, Ogawa U, Iwase S, Yokomichi N, Sakashita A, et al. Current pharmacotherapy does not improve severity of hypoactive delirium in patients with advanced cancer: pharmacological audit study of safety and efficacy in real world (Phase-R). Oncologist. 2019;24(7):e574-e582. doi: 10.1634/theoncologist.2018-0242
https://doi.org/10.1634/theoncologist.20...
) / Level of evidence 3 |
Pharmacological management of hypoactive delirium/223 records of patients attended in Units Palliative Care Units in 38 hospitals. |
To manage hypoactive delirium, cancer patients in advance stages were prescribed the following drugs: haloperidol (37%), quetiapine (23%), chlorpromazine (12%), olanzapine (10%), risperidone (9%), trazodone 5%), aripiprazole (3%), and perospirone (1%). No significant changes were found regarding the efficiency of the drug therapy. The most common adverse effect was the sedation. |
The current systematic data on pharmacovigilance suggests that the current drug therapy for hypoactive delirium in patients with advanced cancer did not result in any improvements in the severity of their situation, especially among those whose death is expected to happen in a few days. It became clear that it is important to establish appropriate goals for the treatment, considering the prognosis of the patient. |
Nothing to report. |
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