In this episode, I’ll discuss the effects of haloperidol and clonidine on the resolution of delirium in critically ill patients.
My practice when treating patients with delirium has been to avoid using any medications unless they are necessary for the safety of either the patient or staff members. This has been based on mostly retrospective studies that do not support using medications to reduce the time to resolution of delirium or other clinically meaningful outcomes.
Recently published in Intensive Care Medicine is a prospective cohort study looking at the effects of haloperidol and clonidine on the resolution of delirium in critically ill patients.
The study cohort was from a mixed ICU and excluded patients with a primary neurological disorder. Over 3000 patients were analyzed, over 1000 of which had delirium. The main outcome was the probability of delirium resolution. Secondary outcomes were delirium duration, number of delirium days, ventilation days, length of stay in the ICU and hospital, and ICU mortality.
The probability that delirium would resolve was lower in patients that receive either haloperidol, clonidine, or both – a negative finding. The odds ratios for delirium resolution were 0.47, 0.78, and 0.45 for haloperidol, clonidine, or both, respectively.
While there was no effect found on mortality, delirious patients who received haloperidol and/or clonidine had slight but statistically significantly longer delirium duration, more delirium and ventilation days, and days in the ICU and in-hospital than untreated delirious patients.
Further supporting the study’s findings, the negative associations on delirium resolution were dose-dependent.
Although not a randomized trial, this study does add to the body of literature that suggests pharmacologic treatment of delirium is not associated with improved outcomes. While there may be a great temptation among clinicians to use medications to fix the problem of delirium, a likely possibility is that additional medications such as haloperidol and clonidine do not positively affect the likelihood of delirium resolution. My practice will remain to avoid these medications unless they seem necessary for the safety of either the patient or staff members.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.