Delirium

Typical neuroleptics

  1. Haldol
    1. 0.5 - 1 mg PO, IM, or IV
    2. Titrate by 2-5 mg every 1 hr until total daily requirement is established
    3. Then administer in 2-3 divided doses per day
  2. Others have more side-effects, but also are good (better?) anti-emetics
    1. Thorazine
      1. Advocated by terminal patients in whom sedation is desired, especially terminal sedation
Atypical neuroleptics
  1. Olanzipine 5 mg PO q day, may also give 2.5-10 mg IM (see reference for dosing, some data below)
    1. May use with fluoxetine
    2. Max 20 mg/day
    3. After one week ↑ dose to 10 mg/day and titrated to 20 mg/day
    4. D/c if ANC < 1000, consider d/c if unexplained ↓ in WBC count
    5. IM dosing
      1. t/c 5 mg/dose in elderly
      2. t/c 2.5 mg/dose in non-smoker, debilitated, female, or hypotension risk
      3. may repeat 2 hrs after initial dose, then 4 hrs after 2nd dose
  2. Seroquel 25 mg PO BID
    1. Every 2-3 days ↑ dose by 25-50 mg per dose (not per day) up to 300-400 mg/day divided into 2-3 doses
  3. Risperidone 1-2 mg PO qhs
    1. Every 2-3 days ↑ dose by 1 mg until effective dose (usually 4-6 mg PO qhs)