Delirium in hospitalized patients: Risks and benefits of antipsychotics

Robyn Pauline Thom; Clare Kelleher Mock; Polina Teslyar

doi:10.3949/ccjm.84a.16077

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TABLE 1

Antipsychotic agents

Agent	Haloperidol	Olanzapine	Quetiapine	Risperidone	Aripiprazole
Dosage forms	Oral tablets, solution Intramuscular and intravenous solutions	Oral tablets, disintegrating tablets Intramuscular solution	Oral tablets, solution	Oral tablets, disintegrating tablets, solution	Oral tablets, solution, distintegrating tablets Intramuscular solution
Starting dose	0.5–1 mg twice a day	2.5–5 mg twice a day	12.5–25 mg twice a day	0.5 mg twice a day	1 mg twice a day
Half-life (hours)	12–38	21–54	6	20	75
Clearance	Hepatic	Hepatic	Hepatic	Hepatic	Hepatic
Common adverse effects	Akathisia Dystonia Parkinsonism	Akathisia Parkinsonism	Agitation	Parkinsonism	Akathisia Agitation
Effects on corrected QT interval	Oral, intramuscular: Mild Intravenous: Moderate	Mild	Mild	Mild	None
Orthostatic hypotension	Mild	Moderate	Severe	Severe	Moderate
Anticholinergic effects^a	Mild	Severe	Moderate	Mild	Mild
Sedation	Mild	Moderate	Severe	Moderate	Moderate
Drug-drug interactions (CYP450 activity)	Substrate of: CYP1A2 (minor) CYP2D6 (major) CYP3A4 (major) Inhibits CYP2D6 (moderate)	Substrate of: CYP1A2 (major) CYP2D6 (minor)	Substrate of: CYP2D6 (minor) CYP3A4 (major)	Substrate of: CYP2D6 (major) CYP3A4 (minor)	Substrate of: CYP2D6 (major) CYP3A4 (major)
Special considerations	Minimal effect on vital signs May worsen stiffness and motor symptoms in Parkinson disease	Comes in dissolvable form Helpful for cancer-related nausea Do not combine with parenteral benzodiazepines due to risk of respiratory depression May worsen control of diabetes	Consider in Parkinson disease	Comes in dissolvable form	May be useful for hypoactive delirium No known effect on QTc