Treatment of delirium with ramelteon: initial experience in three patients

Kimura, Ryo; Mori, Kohji; Kumazaki, Hirokazu; Yanagida, Makoto; Taguchi, Satoki; Matsunaga, Hidenori

doi:10.1016/j.genhosppsych.2011.03.013

Cited by 29 publications

(24 citation statements)

References 16 publications

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“…According to the association between delirium and irregular patterns of melatonin secretion, which has been described by several studies, irregular melatonin secretion could be one of the mechanisms of delirium (10,23,30,31,(50)(51)(52) as well as the presence of sleep deprivation in hospitalized delirious patients at the ICU, as it has been indicated that melatonin and its agonists could be an effective supplement for prevention and management of delirium (38,53,54). Furthermore, several studies have reported the marked improvement of delirium in delirious patients without side effects due to the use of melatonin and ramelteon (6,45,46). According to the literature, pharmacological methods are not yet rec- ommended for prevention of delirium in critically ill patients, based on reviewed studies, especially because melatonin could improve patients' sleep; further trials could be performed to evaluate the efficacy of melatonin on prevention of delirium.…”

Section: Discussionmentioning

confidence: 99%

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Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies

Aghakouchakzadeh

Izadpanah

Soltani

et al. 2017

Jundishapur J Nat Pharm Prod

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Background: Delirium is a neuropsychiatric syndrome, which is a common complication at the intensive care unit (ICU). Delirium is a risk factor for increased duration of mechanical ventilation and increased time of stay at the ICU and death. Melatonin is a hormone produced and secreted by the pineal gland, that regulates circadian rhythm. The aim of this investigation was to demonstrate the effect of melatonin in controlling and improving delirium.

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Section: Discussionmentioning

confidence: 99%

“…Kimura et al (2011) described 3 case reports that were 3 females admitted to the hospital, who illustrated symptoms of delirium during hospitalization and were administrated 8 mg of Ramelteon per day for the treatment of delirium (45). Furuya et al (2012) described 5 cases, 3 of which had a primary neurological disease such as Alzheimer's disease.…”

mentioning

confidence: 99%

Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies

Aghakouchakzadeh

Izadpanah

Soltani

et al. 2017

Jundishapur J Nat Pharm Prod

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“…Based on these limited data, the authors suggested that ramelton may be of benefit in the management of delirium. 3 Five patients with delirium due to varying causes (eg, Alzheimer dementia, steroid psychoses, dementia with Lewy bodies) were treated with oral ramelton (8 mg) at bedtime to modify the sleep-wake cycle. Four patients were unresponsive to previous therapy with various medications, commonly including antipsychotics.…”

Section: Case Reportsmentioning

confidence: 99%

Delirium: Ramelton

Generali

Cada²

2013

Hosp Pharm

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This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@kumc.edu.

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“…14 Furuya and colleagues 15 reported that five elderly patients recovered from delirium within 24 hours with ramelteon (8 mg/d) without any adverse effects, and other case series also showed the same results. 16,17 Our patient's case illustrates the benefit of combined therapy with a melatonin agonist and an atypical antipsychotic in an older delirious patient who responded poorly to either typical or atypical antipsychotics. The modulating effects on the melatonin pathway could inhibit central dopaminergic activities and enhance nicotinic acetylcholine functions.…”

mentioning

confidence: 91%

“…The modulating effects on the melatonin pathway could inhibit central dopaminergic activities and enhance nicotinic acetylcholine functions. 18,19 Current evidence from case series with a limited number of patients supports the use of ramelteon monotherapy in patients with delirium, 16,20 but atypical antipsychotics are still the firstline agents of choice to manage the condition. Adding ramelteon to atypical antipsychotics may help to manage the sundowning phenomenon quickly for older delirious patients with a refractory course.…”

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confidence: 99%

Adjunctive treatment with melatonin receptor agonists for older delirious patients with the sundowning phenomenon

Yeh

Tzeng

et al. 2015

jpn

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A 75-year-old man with Alzheimer dementia (Mini Mental State Examination score = 15) had been followed for 1 year. His behaviour had been well controlled with quetiapine (100 mg/d) before he was admitted to hospital with pneumonia. A fever of 39°, blood pressure of 112/70 mm Hg, heart rate of 69/min, respiratory rate of 18/min, leukocytosis (white blood cell [WBC] count 13.1 × 10 3 /µL) and elevated C-reactive protein (CRP; 15.18 mg/dL) were noted at admission, but there was no obvious desaturation (SaO2 > 95%) or CO 2 retention (Paco 2 42 mm Hg). During treatment with 1 gm of flomoxef administered intravenously 3 times daily for 7 days, his vital signs, laboratory data (WBC 7.6 × 10 3 /µL, CRP 1.37 mg/dL) and biochemical data stabilized with resolution of chest radiographic findings on the fourth day. Despite the improvement, the patient still showed disturbed consciousness, disorientation and physical aggression that met the DSM-IV-TR diagnostic criteria for delirium. He was transferred to our psychiatric unit on the seventh day. All medication except quetiapine was discontinued to minimize drug-drug interaction.Despite up-titrating oral quetiapine (150 mg/d) and intermittent intramuscular injections of low dose haloperidol (2.5 mg), the patient's delirium was refractory at night, manifest as interchanging oversedation and severe psychomotor agitation. His Delirium Rating Scale-Revised-98 (DRS-R-98) score was 36. We added 4 mg of ramelteon administered daily at 9 pm on the tenth day to correct his sleep-wake cycle abnormalities. On his first day taking ramelteon, the man's condition improved, with more than 6 hours of sleep, much less arousal and better daytime orientation. Owing to the persistent sundowning phenomenon (DRS-R-98 = 23), we titrated ramelteon to 8 mg on the 18th day. Over the following 3 days, the patient's scores on the subscales of DRS-R-98 improved, especially in terms of perceptual disturbances, visual hallucination, language, thought process abnormalities and attention. On the 21st day, his delirium resolved, and the final DRS-R-98 score was 10.Delirium is an acute neuropsychiatric syndrome characterized by deranged consciousness and attention deficit with a typical fluctuating course, resulting in greater morbidity and mortality.1 Among pharmaco logic al interventions for delirium, antipsychotics are still recommended as a first choice, 2 but the U.S. Food and Drug Administration has noted that treating elderly patients with atypical antipsychotics is associated with serious adverse effects and increased mortality. 3,4 Previous reports have suggested that delirium can be divided into hyperactive, hypoactive and mixed types.5 The hyperactive type is associated with a low melatonin level and the absence of a normal melatonin secretion rhythm. 6,7 Behavioural characteristics include aggressiveness, hypervigilance, uncooperativeness and poor orientation.8 The sleep-wake cycle-regulating effects of melatonin are probably correlated with delirium. 9 Two clinical trials have shown that exogenous ...

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Treatment of delirium with ramelteon: initial experience in three patients

Cited by 29 publications

References 16 publications

Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies

Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies

Delirium: Ramelton

Adjunctive treatment with melatonin receptor agonists for older delirious patients with the sundowning phenomenon

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