What Medications Prevent Delirium in Elderly Medical Inpatients?

This study demonstrated lower rates of delirium in the melatonin arm, with an impressive number needed to treat (NNT) below six patients; mortality and length of hospital stay were unaffected.3 A delirium-prevention effect of melatonin has not been reproduced in other studies, notably Jaiswal et al, which randomized patients to a placebo or 3 mg of melatonin and found no difference in rates of delirium prevention.7  The melatonin receptor agonist ramelteon also has small but favorable evidence for preventing non-ICU hospitalized delirium. This comes from a study of 67 patients aged 65 years or older who were randomized to receive either placebo or ramelteon 8 mg each night for seven days.6 This study also showed a reduction in delirium with an NNT below four patients. Like melatonin, though, ramelteon use has not been shown to reduce hospital length of stay or mortality.  Routine recommendations for pharmacologic intervention cannot be made secondary to the paucity of compelling, consistent data. If pharmacologic prevention is pursued, the dosage should be consistent with the limited available evidence. Specifically, it is important to note that the study demonstrating the benefit of melatonin uses a dose (0.5 mg) that is a fraction of the dose typically used to treat insomnia.3 This suggests that melatonin may be most effective for delirium prevention at doses much lower than those typically initiated, although further research is needed to validate those findings. Further...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Drug Therapy Geriatrics Key Clinical Questions Medication Source Type: research