High-Dose Neuroleptics and Neuroleptic Rotation for Agitated Delirium Near the End of Life

Reason for the study: Agitated delirium presents unique challenges for hospice and palliative care clinicians. Haloperidol, the recommended neuroleptic, may be ineffective at low dose, or poorly tolerated at higher doses. Main Findings: This article reports on two patients with refractory agitated d...

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Bibliographic Details
Published in:American journal of hospice & palliative medicine 2014-12, Vol.31 (8), p.808-811
Main Authors: Bascom, Paul B., Bordley, Jessica L., Lawton, Andrew J.
Format: Article
Language:English
Subjects:
Adult
Antipsychotic Agents - administration & dosage
Antipsychotic Agents - adverse effects
Antipsychotic Agents - therapeutic use
Delirium - drug therapy
Drug Substitution
Female
Gastrointestinal Neoplasms - complications
Haloperidol - administration & dosage
Haloperidol - adverse effects
Haloperidol - therapeutic use
HIV Infections - complications
Humans
Male
Middle Aged
Nursing
Psychomotor Agitation - drug therapy
Terminal Care - methods
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Summary:Reason for the study: Agitated delirium presents unique challenges for hospice and palliative care clinicians. Haloperidol, the recommended neuroleptic, may be ineffective at low dose, or poorly tolerated at higher doses. Main Findings: This article reports on two patients with refractory agitated delirium. Both developed extrapyramidal symptoms from haloperidol and required rotation to an alternate neuroleptic. Patient #1 received 2000 mg/day oral chlorpromazine. Patient #2 received greater than 200 mg/day sublingual olanzapine. Control of agitation was achieved, though the doses were substantially higher than has previously reported in the literature. Each patient experienced considerable sedation, though this was an acceptable side effect for the family. Each patient was transferred from the acute care hospital to a location of family preference. There they died within a week of transfer. Conclusions: Agitated delirium is a palliative care emergency. High doses of neuroleptic medications, with rotation to an alternate neuroleptic when side effects occur with standard haloperidol, may effectively palliate agitated delirium. This remedy can provide the patient with a peaceful dying in a place of their choosing.
ISSN:1049-9091
1938-2715
DOI:10.1177/1049909113507124