Archive 1992–2014

Aim. The aim of the study was to review the existing clinical trial evidence about the effectiveness and safety of second-generation antipsychotics (APIIG) in symptomatic treatment of delirium, excluding alcohol-related delirium or that following substance abuse.
Method. The database search results obtained using selected keywords (delirium, management, treatment) were limited to original research studies and sorted by APIIG international drug name.
Results. Four randomized controlled clinical trials, 17 prospective open trials and 4 retrospective case record reviews were identified, with the total number of 1113 patients. Risperidone, olanzapine and quetiapine, as well as amisulpride, aripiprazole and perospirone were all found to be potentially effective in symptomatic treatment of delirium. None of the APIIG drugs has been proven to be more efficacious than the standard comparator (haloperidol). However, APIIG were generally better tolerated than haloperidol, namely, their risk of adverse side effects (e.g. parkinsonism, oversedation) was lower.
Conclusions. As the supportive clinical findings are insufficient so far, it seems premature to recommend a routine use of second generation antipsychotics instead of haloperidol in the treatment of delirium. Risperidone, olanzapine and quetiapine, i.e. the APIIG drugs with the largest patient samples investigated, might be proposed as an alternative to haloperidol, especially in patients with respiratory deficiency, at risk for blood pressure changes, and in those with baseline extrapyramidal symptoms. Moreover, secondgeneration antipsychotics should be preferred in the treatment of delirium in patients with a history of poor haloperidol tolerance, involving particularly oversedation and parkinsonism.