Drug-induced delirium

Drug-induced delirium

Drug induced delirium occurs frequently in older patients. Particularly in those who are taking more than 5 medicines a day. Delirium is described as a confusional state that is being acutely developed and fluctuating through the day. There is disorganized thinking with at least two of the following:

a. reduced level of consciousness

b. perceptual disturbances

c. disturbances of sleep-wake cycle

d. increased or decreased psychomotor activity

e. disorientation to time, place or person

f. memory impairment

Drugs that are commonly associated with delirium are shown below:

Cardiac agents that cause delirium

β-blockers: propranolol

Antiarrhythmics: lidocaine, quinidine, amiodarone

Central alpha agonists: methyldopa, clonidine

Calcium-channel blockers: nifedipine, diltiazem

ACE inhibitors: captopril

Diuretics: furosemide, hydrochlorothiazide

Hypotensive agents: nitroprusside Anti-infectives that cause delirium

β-lactams:

penicillin, cephalexin, cefuroxime, ceftazidime, imipenim

Quinolones: ofloxacin, norfloxacin, ciprofloxacin, enoxacin

Antifungals: ketoconazole, amphotericin B

Antivirals: amantadine, zidovudine, zalcitabine, stavudine

Other: metronidazole, trimethoprim-sulfamethoxazole, gentamicin, tobramycin Other medications that cause delirium

Analgesics: meperidine

Non-steroidal anti-inflammatory: indomethacin, ibuprofen, naproxen

Anticonvulsants: phenytoin, primidone, phenobarbital, valproic acid, carbamazepine

Anti-Parkinson's agents: levodopa/carbidopa

Benzodiazepines: diazepam, triazolam, flurazepam, midazolam

H2-antagonists: cimetidine, ranitidine, famotidine

Corticosteroids: prednisone, dexamethasone

Prokinetic agents: metoclopramide

Hemostatics: aminocaproic acid

Stimulants: caffeine, pseudoephedrine

Sedatives: alcohol

Drugs with anticholinergic side effects are shown in detail in the next slide.