| Which medications to avoid in people at risk of delirium: a systematic review. | |
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MedLine Citation:
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PMID: 21068014 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: delirium is a common clinical problem and is associated with adverse health outcomes. Many medications have been associated with the development of delirium, but the strength of the associations is uncertain and it is unclear which medications should be avoided in people at risk of delirium. METHODS: we conducted a systematic review to identify prospective studies that investigated the association between medications and risk of delirium. A sensitivity analysis was performed to construct an evidence hierarchy for the risk of delirium with individual agents. RESULTS: a total of 18,767 studies were identified by the search strategy. Fourteen studies met the inclusion criteria. Delirium risk appears to be increased with opioids (odds ratio [OR] 2.5, 95% CI 1.2-5.2), benzodiazepines (3.0, 1.3-6.8), dihydropyridines (2.4, 1.0-5.8) and possibly antihistamines (1.8, 0.7-4.5). There appears to be no increased risk with neuroleptics (0.9, 0.6-1.3) or digoxin (0.5, 0.3-0.9). There is uncertainty regarding H(2) antagonists, tricyclic antidepressants, antiparkinson medications, steroids, non-steroidal anti-inflammatory drugs and antimuscarinics. CONCLUSION: for people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium, but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. |
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Authors:
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Andrew Clegg; John B Young |
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Publication Detail:
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Type: Journal Article; Review Date: 2010-11-09 |
Journal Detail:
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Title: Age and ageing Volume: 40 ISSN: 1468-2834 ISO Abbreviation: Age Ageing Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-14 Completed Date: 2011-04-11 Revised Date: 2012-05-01 |
Medline Journal Info:
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Nlm Unique ID: 0375655 Medline TA: Age Ageing Country: England |
Other Details:
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Languages: eng Pagination: 23-9 Citation Subset: IM |
Affiliation:
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Dunhill Medical Trust Research Fellow, Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK. andrewpaulclegg@yahoo.co.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Analgesics, Opioid / contraindications* Benzodiazepines / contraindications* Delirium / epidemiology* Dihydropyridines / contraindications Histamine Antagonists / contraindications Humans Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Dihydropyridines; 0/Histamine Antagonists; 12794-10-4/Benzodiazepines |
| Comments/Corrections | |
Comment In:
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Ann Intern Med. 2011 Jun 21;154(12):JC6-10
[PMID:
21690588
]
Ann Emerg Med. 2012 Apr;59(4):321-2 [PMID: 21839541 ] Evid Based Nurs. 2011 Jul;14(3):75-6 [PMID: 21406536 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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