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ACP Journal Club |21 March 2017

In patients receiving palliative care, risperidone or haloperidol increased delirium symptoms vs placebo

Justin Lee, BScPhm, MD; Anne Holbrook, MD, PharmD

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Agar MR, Lawlor PG, Quinn S, et al. Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomized clinical trial. JAMA Intern Med. 2017;177:34-42. 27918778

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Hospitalists:

In patients receiving palliative care, does risperidone or haloperidol reduce symptoms of distress-associated delirium compared with placebo?
Randomized placebo-controlled trial (RCT). ACTRN12607000562471.
Concealed.*
Blinded* (patients and investigators).
3 days.
11 inpatient hospice or palliative care services in Australia.
249 adults (mean age 75 y, 65% men, 88% with cancer) who had life-limiting illness, were receiving inpatient hospice or palliative care, had Memorial Delirium Assessment Scale (MDAS) score ≥ 7, and had Nursing Delirium Screening Scale (NuDESC) symptom score ≥ 1 based on the sum of the inappropriate behavior, inappropriate communication, and illusions and hallucinations subscores (score range 0 to 6). Exclusion criteria included delirium from substance withdrawal, antipsychotic drug use within 48 hours, expected survival ≤ 7 days, contraindication to antipsychotic drugs, extrapyramidal disorders, prolonged QT interval, neuroleptic malignant syndrome, or cerebrovascular accident or seizure in the past 30 days.
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Lee J, Holbrook A. In patients receiving palliative care, risperidone or haloperidol increased delirium symptoms vs placebo. Ann Intern Med. ;166:JC32. doi: 10.7326/ACPJC-2017-166-6-032

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Published: Ann Intern Med. 2017;166(6):JC32.

DOI: 10.7326/ACPJC-2017-166-6-032

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2017 American College of Physicians
2 Citations

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