Class Summary. Benzodiazepines are preferred over neuroleptics for treatment of delirium resulting from alcohol or sedative hypnotic withdrawal. They also may be used when unknown substances may have been ingested and may be helpful in delirium from hallucinogen, cocaine, stimulant, or PCP toxicity.
Full Answer
Which benzodiazepines are used in the treatment of delirious patients?
Among the benzodiazepines, midazolam and lorazepam are considered drugs of choice for management of agitation in delirious patients because of their rapid onset of action, short half-life, and parenteral route availability.
What is the role of lorazepam in the treatment of terminal delirium?
Lorazepam may be added to haloperidol as rescue for the management of persistent restlessness/agitation in patients with terminal delirium. Patients who present with refractory agitation may require palliative sedation with continuous infusion of benzodiazepine.
When is psychopharmacotherapy indicated in the treatment of delirium?
It is of importance to note that psychopharmacotherapy with antipsychotics is mainly indicated for the hyperactive form of delirium and psychotic symptoms (e.g., delusions or hallucinations) in the hyper- and hypoactive delirium.
Which neuroleptics are used in the treatment of delirium?
Breitbart W, Marotta R, Platt MM et al.: A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized aids patients. The American Journal of Psychiatry1996; 153:231–237. [PubMed] [Google Scholar] 28. Hui D, Valentine A, Bruera E: Neuroleptics for delirium: More research is needed.
Why do benzodiazepines cause delirium?
(C) Central nervous system drugs Benzodiazepines are lipid soluble medications that have a prolonged half life in the elderly because of accumulation in lipid tissue. Because of the extended duration of action and increased sensitivity to sedative hypnotics in the elderly, benzodiazepines can cause delirium.
What are the indications of benzodiazepines?
Indications for benzodiazepine administration include, but are not limited to, anxiety disorders, insomnia, acute status epilepticus, induction of amnesia, spastic disorders, seizure disorders, and agitation.
What are some concerns about the use of benzodiazepines in the elderly for the treatment of anxiety?
Benzodiazepines can impair cognition, mobility, and driving skills in older people, as well as increase the risk of falls. A recent study also found an association between benzodiazepine use in older people and increased risk of Alzheimer's disease.
Are benzodiazepines contraindicated in delirium?
Two other studies have found benzodiazepines can cause or worsen delirium. In conclusion, there is no evidence for use of benzodiazepines to manage behavioral symptoms in delirium. Benzodiazepines alone are not safer than antipsychotics and are not indicated for treating non-alcohol–related delirium.
For what conditions are benzodiazepines prescribed?
Benzodiazepines are a class of drugs that can treat a range of conditions. Doctors often prescribe them to treat anxiety, seizures, and insomnia. The short-term use of these medications is usually safe and effective, but long-term use can lead to tolerance, dependence, and other adverse effects.
What is the action of benzodiazepines?
Benzodiazepines are a group of CNS depressants which induce feelings of calm (anxiolysis), drowsiness and sleep. They act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS.
What are the side effects of benzodiazepines?
The most common side effects of benzodiazepines include:drowsiness.light-headedness.confusion.unsteadiness (especially in older people, who may fall and experience injuries)dizziness.slurred speech.muscle weakness.memory problems.More items...
What is the most serious risk associated with the use of benzodiazepine?
Benzodiazepines increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fracture. The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol.
What major side effects should all elderly patients avoid while taking benzodiazepines?
Benzodiazepines should be used with extreme caution in the elderly due to the risk for excessive sedation, confusion, falls and fractures.
What drugs cause delirium?
Anticholinergic medications, benzodiazepines, and narcotics in high doses are common causes of drug induced delirium.
What is the best treatment for delirium?
How is delirium treated?Antibiotics for infections.Fluids and electrolytes for dehydration.Benzodiazepines for problems due to drug and alcohol withdrawal.
What are benzodiazepines?
Benzodiazepines (pronounced 'ben-zoh-die-AZ-a-peens') are drugs which slows down messages travelling between the brain and body. Other depressants include alcohol, cannabis and heroin. Benzodiazepines are also minor tranquillisers, usually prescribed by doctors to relieve stress and anxiety and to help people sleep.
Why are benzodiazepines prescribed?
Currently, benzodiazepines are often prescribed for the indications of anxiety, insomnia due to anxiety or situational stress, premedication for anesthetic procedure, and status epilepticus. The pharmacokinetic properties of some commonly used benzodiazepines are shown in Table 1.
What is the role of benzodiazepines in alcohol withdrawal?
In addition to agitation in the terminal delirium, benzodiazepines have an established role in the management of patients with alcohol withdrawal to prevent and/or treat delirium tremens, seizures and withdrawal symptoms.
What is the best medication for agitation?
Long-acting benzodiazepines such as diazepam are typically used, with short-acting agents reserved for patients with impaired hepatic metabolism (e.g. liver failure, elderly). Optimal medication regimen for management of agitation in patients with delirium.
Is Lorazepam better than Haloperidol?
A recent randomized trial suggests that lorazepam in combination with haloperidol as rescue medication was more effective than haloperidol alone for the management of persistent restlessness/agitation in patients with terminal delirium.
Is oxazepam metabolized by conjugation?
In contrast, lorazepam, oxazepam and temazepam are metabolized primarily by conjugation and do not have active metabolites, making them more appropriate for patients with liver dysfunction [23]. Management of agitation in delirious patients under palliative care.
Can you add lorazepam to haloperidol?
Lorazepam may be added to haloperidol as rescue for the management of persistent restlessness/agitation in patients with terminal delirium. Patients who present with refractory agitation may require palliative sedation with continuous infusion of benzodiazepine.
What is delirium in palliative care?
Delirium is a frequent condition in patients in a palliative care situation and most often associated with substantial burden or even danger for the persons concerned as well as caregivers and health-care-professionals. Despite the lack of randomized-controlled-trials (RCTs) benzodiazepines and neuroleptic agents are used extensively in palliative ...
Can mask delirium be used in severe symptomatic patients?
Thus, they should only be used in severely symptomatic patients and the duration of the medication has to be limited in time.
Can neuroleptics cause agitation?
Severe agitation and aggressivity can be an indication for neuroleptics, when non-pharmacological interventions fail, whereas the use of benzodiazepines has to be limited to critical situations where neuroleptics cannot be applied and cases of delirium due to alcohol withdrawal.
Is delirium a condition?
Delirium is a frequent condition in patients in a palliative care situation and most often associated with substantial burden or even danger for the persons concerned as well as caregivers and health-care-professionals. Despite the lack of randomized-controlled-trials (RCTs) benzodiazepines and neur …. Delirium is a frequent condition in patients ...