Truth Be Told or Still not Sold? The Case for Benzodiazepines in the Palliative Management of Delirium
The current palliative management of delirium involves (1) identification of reversible causes of delirium, (2) non-pharmacologic measures, and (3) pharmacologic interventions for palliation. Clinicians reserve pharmacologic interventions for cases of hyperactive delirium or refractory delirium. Specific pharmacologic agents treating delirium have typically involved using drugs from the neuroleptic class. Often families request sedation for their loved one, complicating neuroleptic choice. Early randomized controlled trials found that benzodiazepines cause worsening delirium. Other research showed that benzodiazepines and central nervous system depressants cause significant complications in the elderly leading to further avoidance. The avoidance of benzodiazepines continued as guidelines warned of their use in delirium except in the case of alcohol withdrawal. Recent randomized controlled trials suggest that benzodiazepines are effective when sedation is required as part of the delirium treatment strategy. There is also evidence for their benefit as breakthrough agents for delirium. As benzodiazepines are potent sedatives, clinicians need to carefully weigh the risks and benefits before prescribing benzodiazepines in patients with delirium and discuss the goals of care with family caregivers and patients (if possible). Identifying when to use, how to use, and what patients will benefit from benzodiazepines becomes essential.
Hospice Medical Directors
To provide guidance, a panel of palliative care specialists and palliative pharmacologists will, through case presentation didactics and audience participation, enable attendees to:
1. Explain the current evidence for the use of benzodiazepine in delirium from randomized control trials;
2. Identify optimal benzodiazepines to use for delirium based on their pharmacology;
3. Recognize where and when benzodiazepines can benefit delirium management
4. Identify the patients that will benefit the most from the use of benzodiazepines for delirium;
5. Develop communication strategies with patients and families when contemplating benzodiazepine use for delirium.
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All editors, faculty and staff have disclosed no relevant financial relationships.
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Sandra DiScala, PharmD
Eric Prommer, MD HMDC FAAHPM
Mary Lynn McPherson, PharmD MA MDE BCPS
David Hui, MD MSC FAAHPM
Maria Lowry, PharmD
Julie Bruno, MSW LCSW
Julie Tanner, BSN RN-BC CHPN
Julie Tanner, BSN RN-BC CHPN
This recorded activity is a non-accredited learning resource. No CME or MOC is offered with this activity.