Case Reports: Antipsychotics are frequently used for Intensive Care Unit (ICU) associated delirium. Lurasidone is a new atypical antipsychotic FDA approved for schizophrenia and is associated with less QTc prolongation. This case series describes the use of lurasidone for ICU delirium. Case #1: 63 yo male diagnosed with tuberculosis. Hospital day (HD) 6 transferred to ICU for respiratory failure. HD 18 quetiapine initiated for ICU delirium. After one day of quetiapine, QTc increased from 582 to 671 (no other QTc prolonging agents given) so switched to lurasidone 40mg daily. HD 20 lurasidone increased to 80mg daily. CAM-ICU negative and QTc decreased to 474 on HD 21. No PRN haloperidol required. Remained CAM-ICU negative; lurasidone DC’d after 16 days. HD 38 transferred out of ICU. HD 42 became hypoxic and returned to ICU. CAM-ICU positive on HD 49; lurasidone reinitiated due to history of QTc prolongation. HD 51 was CAM-ICU negative and remained so until ICU discharge on HD 57. Case #2: 48 yo male with history of alcohol abuse admitted with ankle fracture. HD 4 transferred to ICU for delirium tremens. HD 7 quetiapine 50mg q12 started for ICU delirium. By HD 17 quetiapine increased to 250mg q8 and remained agitated. QTc increased to 490; lurasidone 80mg daily added to enable quetiapine taper. By HD 23 quetiapine was decreased to 100mg q8. Transferred out of ICU on lurasidone and quetiapine with plans to continue quetiapine taper. Case #3: 50 yo male with extensive cardiac history admitted for pneumonia. HD 2 transferred to ICU for respiratory distress. HD 4 started quetiapine 25mg q8 for ICU delirium. Quetiapine gradually increased to 200mg q8 by HD 14. HD 15 extremely agitated and violent with staff members. Haloperidol 10mg IV q4 initiated and quetiapine decreased to 150mg QHS. HD 17 still heavily agitated despite increase in haloperidol. Haloperidol DC’d and lurasidone 40mg daily initiated to avoid QTc prolonging agents. HD 18 minimal PRN haloperidol needed and notably less agitated; transferred out of ICU on lurasidone and quetiapine.
Conclusion: Lurasidone appears to be efficacious and safe for the management of ICU delirium, specifically in patients with prolonged QTc.