Loxapine for Management of Delirium in Older Adult Surgical Patients
DOI:
https://doi.org/10.12970/2310-8231.2017.05.05Keywords:
Delirium, antipsychotic, loxapine, haloperidol, surgery, geriatrics, elderly.Abstract
The use of antipsychotics for the treatment of post-operative delirium is often practiced after non-pharmacologic methods of re-orientation have failed. Loxapine is a drug with medium-potency antagonism at dopamine receptors and is used frequently at our institution for delirium. In this small uncontrolled open-label study, we provide early findings that it is effective at reducing the severity and duration of delirium in an older population and may be a reasonable alternative for management. Delirium Rating Scale (DRS-R-98) scores were recorded in 31 older adult surgical patients (mean age 72, 2/3 male). Treating physicians ordered loxapine according to clinical judgment. We monitored for extrapyramidal side-effects, QTc changes, and other adverse events. The mean maximum cumulative loxapine dose per day was 44mg (s.d. 31). DRS-R-98 score after 2 days of treatment (mean 10.19, s.d. 6.61) was significantly reduced compared to DRS-R-98 score at time of diagnosis (mean 18.68, s.d. 4.66) [t(30) = 6.65, p < 0.001]. The mean number of days to resolution of delirium was 3.2 (s.d. 2.5). Only 3 participants experienced very mild extrapyramidal symptoms and there was no significant difference between baseline QTc (mean 422ms, s.d. 19.86) and mean QTc during treatment (mean 426ms, s.d. 18.47) in a subsample for which QTc data were available [t(11) = 0.45, p > 0.5]. Although there are several limitations to this small uncontrolled open-label study, the findings suggest loxapine is a reasonable alternative in treating delirium in older adult surgical patients.
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