Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial

Abstract

Background Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. Methods This study was a randomized double-blind controlled trial conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients aged ≥65 years hospitalized in the internal medicine service were randomized to quetiapine 12.5 mg or placebo once daily at bedtime for a maximum 7-day duration. The primary end point was delirium incidence. Secondary end points were delirium duration, length of hospital stay, ICU admission, rehospitalization and mortality within 30 and 90 days. Results A total of 122 patients were enrolled in the study. Eight (6.6%) left the trial before receiving the first dose of the intervention, whereas 114 (93.4%) were included in an intention-to-treat analysis allocated to the quetiapine or placebo group (n = 57 each). The delirium incidence rates in the quetiapine and placebo groups were 14.0 and 8.8% (OR = 1.698, 95% CI 0.520–5.545, P = 0.381), respectively. Other endpoints in the quetiapine and placebo groups were the median length of hospital stay, 6 (4–8) days versus 5 (4–8) days (P = 0.133), respectively; delirium duration, 4 (2.3–6.5) versus 3 (1.5–4.0) days (P = 0.557), respectively; ICU admission, 3 (5.3%) patients from both groups (P = 1.000); and mortality in the quetiapine and placebo groups, 1 (1.8%) versus 2 (3.5%) at 30 days (P = 0.566) and 7 (12.3%) versus 9 (15.8%) days at 90 days (P = 0.591). There were no significant differences in other outcomes. None of the participants reported adverse events. Conclusions Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients. The use of quetiapine to prevent delirium in this population group should not be recommended. Trial registration This trial was retrospectively registered with the Thai clinical trials registry (TCTR) at clinicaltrials.in.th (TCTR20190927001) on September 26, 2019.

Evaluation of the Efficacy and Safety of Quetiapine in the Treatment of Delirium in Adult ICU Patients: A Retrospective Comparative Study

“…In another trial comparing quetiapine (n = 24) to haloperidol (n = 28), one patient with malignancy and sepsis died in each study arm [18]. Furthermore, quetiapine failed to improve the length of hospital or ICU stay, or to reduce mortality, when it was used either as a delirium prevention agent in older or high-risk patients, or as a treatment agent for hypoactive delirium [37][38][39].…”

Effect of prophylactic perphenazine on delirium after extubation in severe acute pancreatitis

“…Several clinical trials have investigated its effects on the incidence of delirium in critically ill patients, and the results suggest that dexmedetomidine may effectively reduce the incidence of delirium in this population [29,30]. Saran et al reported that quetiapine prophylactic therapy does not reduce the incidence of delirium in hospitalized elderly patients [31]. However, treatment with antipsychotic drugs and antidepressants can alleviate delirium symptoms in some hospitalized patients [32].…”

Veno-venous Extracorporeal Membrane Oxygenation: Anesthetic Considerations in Clinical Practice

“…Among olanzapine, risperidone, haloperidol, and quetiapine, quetiapine has been the most extensively studied. A dose of 12.5 mg each evening was found to be insufficient in reducing the risk of delirium (14). The authors suggest that a higher dose in a more selective subgroup might be beneficial for quetiapine.…”

“…COVID-19 infection does not appear to present significant challenges in terms of sedation or allowing physical therapy in VV-ECMO patients. Among opioids, melatonin, benzodiazepines, and antidepressants, only antipsychotics have been shown to be effective in preventing delirium after discontinuing dexmedetomidine (14). Haloperidol, at a dose of 1 mg, is also utilized to prevent nausea in postoperative general surgery patients and to prevent delirium (as reported in the recovery room anesthesia order set by the University of California).…”