Follow-up of antipsychotic therapy for delirium in palliative care

When using an antipsychotic for delirium:

• Use the lowest effective antipsychotic dose for the shortest period of time.
• Monitor symptoms of delirium (eg agitation, psychosis) and observe for common adverse effects of antipsychotics (see Approximate relative frequency of common adverse effects of antipsychotics in the Psychotropic guidelines for approximate relative frequency of common adverse effects); ongoing delirium can be an antipsychotic adverse effect.
• If multiple antipsychotic doses are required, review the diagnosis and management plan. In particular, optimise nonpharmacological measures (see Preventing delirium in palliative care). A short course (eg 48 to 72 hours) of regular low-dose antipsychotic therapy may be appropriate for patients who initially respond to an antipsychotic but experience persistent severe distress. Timing of doses may be determined by timing of symptoms (eg early evening dose may be preferable for patients with nocturnal agitation).