Quetiapine for the treatment of delirium.

BACKGROUND: Delirium is associated with high rates of morbidity and mortality in hospitalized medically ill patients. Haloperidol has historically been the agent of choice for the treatment of delirium, but recent studies have explored the efficacy of second-generation antipsychotics such as quetiapine. The unique pharmacology of quetiapine may allow it to treat delirium and provide sedation without causing significant extrapyramidal side effects.
PURPOSE: To evaluate the efficacy of quetiapine for the treatment of delirium. DATA SOURCES: A search was conducted in MEDLINE and Embase (January 1960-December 2012) using keywords "quetiapine," "second-generation antipsychotic," "atypical antipsychotic," "delirium," and "agitation." STUDY SELECTION AND DATA EXTRACTION: The search was limited to English-language articles and trials with treatment of delirium as the primary end point. Eight trials met this inclusion criterion. DATA SYNTHESIS: Two randomized controlled trials, 5 open-label studies, and 1 retrospective cohort study evaluating quetiapine for the treatment of delirium were reviewed. One randomized controlled trial showed no differences in total mean delirium scores, but found the rate of delirium improvement was significantly shorter with quetiapine. The second randomized controlled trial showed the time to first resolution of delirium was shorter with quetiapine compared to placebo. Results of the open-label and retrospective cohort trials have also shown significant resolution of delirium from baseline and equal efficacy with quetiapine compared to amisulpride and haloperidol.
CONCLUSIONS: Quetiapine appears to be an effective and safe agent for the treatment of delirium in both general medicine and intensive care unit patients. The trials summarized suggest that quetiapine resolves symptoms of delirium more quickly than placebo and has equal efficacy compared to haloperidol and the atypical antipsychotic amisulpride. Further study is needed.