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Benzodiazepines for agitation in patients with delirium

selecting the right patient, right time, and right indication

Hui, David

Current Opinion in Supportive and Palliative Care: December 2018 - Volume 12 - Issue 4 - p 489–494
doi: 10.1097/SPC.0000000000000395
END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston
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Purpose of review To provide an evidence-based synopsis on the role of benzodiazepines in patients with agitated delirium.

Recent findings Existing evidence supports the use of benzodiazepines in two specific delirium settings: persistent agitation in patients with terminal delirium and delirium tremens. In the setting of terminal delirium, the goal of care is to maximize comfort, recognizing that patients are unlikely to recover from their delirium. A recent randomized trial suggests that lorazepam in combination with haloperidol as rescue medication was more effective than haloperidol alone for the management of persistent restlessness/agitation in patients with terminal delirium. In patients with refractory agitation, benzodiazepines may be administered as scheduled doses or continuous infusion for palliative sedation. Benzodiazepines also have an established role in management of delirium secondary to alcohol withdrawal. Outside of these two care settings, the role of benzodiazepine remains investigational and clinicians should exercise great caution because of the risks of precipitating or worsening delirium and over-sedation.

Summary Benzodiazepines are powerful medications associated with considerable risks and benefits. Clinicians may prescribe benzodiazepines skillfully by selecting the right medication at the right dose for the right indication to the right patient at the right time.

Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, USA

Correspondence to David Hui, MD, MSc, Department of Palliative Care, Rehabilitation and Integrative Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1 713 792 6258; fax: +1 713 792 6092; e-mail: dhui@mdanderson.org

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