Antipsychotics Worsen Symptoms in Patients with Delirium Who Receive Palliative Care


Am Fam Physician. 2017 Mar 15;95(6):online.

Clinical Question

Do antipsychotic drugs improve symptoms of distress associated with delirium in patients receiving palliative care?

Bottom Line

For hospitalized patients with acute delirium and symptoms of distress who are receiving palliative care, the use of risperidone (Risperdal) or haloperidol at conservative oral doses worsens symptoms and may shorten overall survival. (Level of Evidence = 1b)


These researchers enrolled 247 hospitalized patients who were receiving palliative care and had delirium-related symptoms of distress. Patients were randomized, using concealed allocation, to receive oral risperidone, haloperidol, or placebo for 72 hours for the management of these symptoms. There were slightly more than 80 patients in each of the three arms. The initial dosage for risperidone and haloperidol was 1 mg, with maintenance dosages of 0.5 mg every 12 hours

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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Apr 15, 2017

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