“Remarkable” study shows antipsychotics to treat delirium in palliative care do more harm than good

January 6, 2017

A randomized controlled trial found that two antipsychotic drugs commonly used to manage delirium in patients receiving palliative care actually make the symptoms worse. Delirium is a mental disorder with symptoms including hallucinations, confusion and inappropriate behaviour. It is common in palliative care units, especially for patients near the end of their lives. Antipsychotic drugs like risperidone and haloperidol are often given to treat some of these symptoms. Dr. Peter Lawlor co-authored a trial published in JAMA Internal Medicine that gave 247 patients with delirium from 11 Australian palliative care centres oral doses of risperidone, haloperidol or a placebo for three days. The team found that patients given the antipsychotics had worse delirium symptoms and were 1.5 times more likely to die compared to patients given a placebo. The authors recommend that antipsychotics not be used to treat palliative care patients with mild or moderate delirium. An accompanying commentary calls the study “remarkable” and hopes the findings will be immediately translated into practice. Dr. Lawlor is a clinician investigator at The Ottawa Hospital and the Bruyère Research Institute, as well as a palliative care physician at Bruyère Continuing Care and an associate professor at the University of Ottawa.

Co-authors: Meera R. Agar, PhD; Peter G. Lawlor, MB; Stephen Quinn, PhD; Brian Draper, MD; Gideon A. Caplan, MBBS;Debra Rowett, BPharm; Christine Sanderson, MPH; Janet Hardy, MD; Brian Le, MBBS; Simon Eckermann, PhD;Nicola McCaffrey, PhD; Linda Devilee, MBus; Belinda Fazekas, BN; Mark Hill, PhD; David C Currow, PhD

Funding: The Australian Government’s Department of Health under the National Palliative Care Strategy, National Health and Medical Research Council, Australia

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