The use of benzodiazepines to control agitation in delirium in the last days of life is controversial.
Dr David Hui and colleagues compared the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer.
The research team performed a single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from 2014 to 2016, with data collection completed in 2016.
Lorazepam intravenously or placebo in addition to haloperidol intravenously upon the onset of an agitation episode.
|The most common adverse effect was hypokinesia|
|Journal of the American Medical Association|
The team's primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score, communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival.
Among 90 randomized patients, 64% received the study medication and 90% completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours than placebo + haloperidol.
The researchers found that lorazepam + haloperidol group required less median rescue neuroleptics than the placebo + haloperidol group, and was perceived to be more comfortable by both blinded caregivers and nurses.
The team observed no significant between-group differences in delirium-related distress and survival.
The most common adverse effect was hypokinesia.
Dr Hui's team concludes, "In this preliminary trial of hospitalized patients with agitated delirium in the setting of advanced cancer, the addition of lorazepam to haloperidol compared with haloperidol alone resulted in a significantly greater reduction in agitation at 8 hours."
"Further research is needed to assess generalizability and adverse effects."