Document Type : Original Article


1 Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 2Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

6 Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Objective: Delirium is one of the most common complications in patients admitted
to intensive care units (ICUs). Delirium is a definite cause for more extended hospital
stays, higher mortality rates, and possibly persistent cognitive decline in the future.
Antipsychotics have been frequently evaluated as first drugs of choice, but the most
appropriate, evidence-based treatment is yet to be discovered. This study aims to compare
the efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU.
Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICU
admitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosis
was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-V) criteria for delirium, and clinical toxicologists included the patients according
to the study’s inclusion and exclusion criteria. Patients received either haloperidol or
olanzapine based on computerized randomization. The severity of delirium was measured
with the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICUadmission.
Results: The total sample size was 35 in which 16 patients received haloperidol, and 19
patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg three
times a day and 5 mg three times a day, respectively. There was no significant difference in
baseline characteristics and the scores of MDAS between groups.
Conclusion: Olanzapine and haloperidol have the same efficacy in the management
of delirium in toxicology ICU-admitted patients. They can be interchangeably used for
delirium treatment in these patients


Main Subjects

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington, VA: American Psychiatric Association; 2013.
2. Liptzin B, Levkoff SE, Gottlieb GL, Johnson JC. Delirium. J Neuropsychiatry Clin Neurosci 1993; 5(2): 154-60. doi:10.1176/jnp.5.2.15
3. Cascella M, Fiore M, Leone S, Carbone D, Di Napoli R. Current controversies and future perspectives on treatment of intensive care unit delirium in adults. World J Crit Care Med 2019; 8(3): 18-27. doi:10.5492/wjccm.v8.i3.18.
4. Jayaswal AK, Sampath H, Soohinda G, Dutta S. Delirium in medical intensive care units: incidence, subtypes, risk factors, and outcome. Indian J Psychiatry 2019; 61(4): 352- 8. doi: 10.4103/psychiatry.IndianJPsychiatry_583_18.
5. Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015; 350: h2538. doi:10.1136/bmj.h2538.
6. Trzepacz PT. Is there a final common neural pathway in delirium? focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000; 5(2): 132-48. doi: 10.153/scnp00500132.
7. Bush SH, Tierney S, Lawlor PG. Clinical assessment and management of delirium in the palliative care setting. Drugs 2017; 77(15): 1623-43. doi: 10.1007/s40265-017-0804-3.
8. Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci 2013; 67(5): 323-31. doi: 10.1111/pcn.12066.
9. Rea RS, Battistone S, Fong JJ, Devlin JW. Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy 2007; 27(4): 588-94. doi: 10.1592/phco.27.4.588.
10. Ozbolt LB, Paniagua MA, Kaiser RM. Atypical antipsychotics for the treatment of delirious elders. J Am Med Dir Assoc 2008; 9(1): 18-28. doi: 10.1016/j.jamda.2007.08.007.
11. Burry L, Mehta S, Perreault MM, Luxenberg JS, Siddiqi N, Hutton B, et al. Antipsychotics for treatment of delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2018; 6(6): CD005594. doi: 10.1002/14651858.
12. Barbateskovic M, Krauss SR, Collet MO, Larsen LK, Jakobsen JC, Perner A, et al. Pharmacological interventions for prevention and management of delirium in intensive care patients: a systematic overview of reviews and metaanalyses. BMJ Open 2019; 9(2): e024562. doi: 10.1136/
13. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The memorial delirium assessment scale. J Pain Symptom Manage 1997; 13(3): 128-37. doi: 10.1016/s0885- 3924(96)00316-8.
14. Boettger S, Jenewein J, Breitbart W. Haloperidol, risperidone,molanzapine and aripiprazole in the management of delirium: a comparison of efficacy, safety, and side effects. Palliat Support Care 2015; 13(4): 1079-85. doi: 10.1017/s1478951514001059.
15. Yoon HJ, Park KM, Choi WJ, Choi SH, Park JY, Kim JJ, et al. Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium. BMC Psychiatry 2013; 13: 240. doi: 10.1186/1471-244x-13-240.
16. Grover S, Kumar V, Chakrabarti S. Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium. J Psychosom Res 2011; 71(4): 277-81. doi:10.1016/j.jpsychores.2011.01.019.
17. Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database Syst Rev 2007; (2): CD005594. doi: 10.1002/14651858.CD005594.pub2.