• Widescreen
    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:

    • reduced level of consciousness
    • perceptual disturbances
    • isturbances of sleep-wake cycle
    • increased or decreased psychomotor activity
    • disorientation to time, place or person
    • 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.