Haloperidol shows no clear advantage for delirium treatment in hospitalized patients, finds study

Haloperidol shows no clear advantage for delirium treatment in hospitalized patients, finds a study published in the Annals of Internal Medicine. However, it may offer some prevention benefits in postoperative settings. Findings from two systematic reviews are published in Annals of Internal Medicine.

Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. It often occurs after an acute illness or surgery and may affect up to 50 percent of hospitalized older adults. Antipsychotics are used to prevent and treat delirium, but their benefits and harms are unclear.

Researchers from Johns Hopkins University School of Medicine reviewed 14 randomized controlled trials (RCTs) to examine the benefits and harms of haloperidol or second-generation antipsychotics for preventing delirium in adults, and 16 RCTs and 10 observational studies to examine the benefits and harms of haloperidol or second-generation antipsychotics for treating delirium in adults. With regard to prevention, the researchers found little or no evidence to determine the effects of antipsychotics on cognitive function, delirium severity, caregiver burden, or sedation. Haloperidol did not appear to prevent delirium, although the research suggests that there may be some benefit with second-generation antipsychotics in postoperative settings.

With regard to treating delirium, both haloperidol and second-generation antipsychotics did not demonstrate any clear benefit compared to placebo. Using haloperidol or second-generation antipsychotics to prevent or treat delirium did not decrease the length of hospital stay and made little or no difference in sedation or neurologic side effects but potentially harmful cardiac side effects did occur more frequently.

According to the study authors, future trials should use standardized outcome measures, as more research is needed to assess the effects of antipsychotics on patient agitation and distress, subsequent memories of delirium, caregiver burden and distress, an inappropriate continuation of antipsychotic therapy, and long-term cognitive functional outcomes.

For reference, follow the link

http://annals.org/aim/article/doi/10.7326/M19-1859