Historically, a relatively short list of medications, including anticholinergics, benzodiazepines, and narcotics, has been associated with the development of delirium; however, it is now accepted that any medication, if administered to individuals at risk, such as those with frailty and/or dementia, can precipitate it. Knowing the potential danger of these medications in terms of delirium development is key, given the impact that delirium exerts on healthcare and clinical patient’s outcomes. However, medications may also have a favorable effect to prevent and manage it in selected patients. This article reviews the mechanisms of drug-induced delirium, including the role of drugs as both predisposing and precipitating factors and the role of neurotransmitter imbalances involving acetylcholine, dopamine, and gamma aminobutyric acid in the pathophysiology of drug-induced delirium. Furthermore, it discusses the role of polypharmacy as a causing factor of delirium, the scales used to assess the patient’s drug burden of delirium, the medication candidates for delirium prevention, and the medications that may be used to treat delirium.
Bellelli, G., Morandi, A. (2023). Optimizing Pharmacotherapy in Older Patients: Delirium. In A. Cherubini, A.A. Mangoni, D. O’Mahony, M. Petrovic (a cura di), Optimizing Pharmacotherapy in Older Patients An Interdisciplinary Approach (pp. 173-183). Springer Nature [10.1007/978-3-031-28061-0_14].
Optimizing Pharmacotherapy in Older Patients: Delirium
Bellelli G.
Primo
;
2023
Abstract
Historically, a relatively short list of medications, including anticholinergics, benzodiazepines, and narcotics, has been associated with the development of delirium; however, it is now accepted that any medication, if administered to individuals at risk, such as those with frailty and/or dementia, can precipitate it. Knowing the potential danger of these medications in terms of delirium development is key, given the impact that delirium exerts on healthcare and clinical patient’s outcomes. However, medications may also have a favorable effect to prevent and manage it in selected patients. This article reviews the mechanisms of drug-induced delirium, including the role of drugs as both predisposing and precipitating factors and the role of neurotransmitter imbalances involving acetylcholine, dopamine, and gamma aminobutyric acid in the pathophysiology of drug-induced delirium. Furthermore, it discusses the role of polypharmacy as a causing factor of delirium, the scales used to assess the patient’s drug burden of delirium, the medication candidates for delirium prevention, and the medications that may be used to treat delirium.
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