Intravenous haloperidol or chlorpromazine-which is more effective to improve agitation and communication in agitated delirium at the end of life?

Background: Delirium frequently occurs in terminally ill patients with cancer. The purpose of this study was to determine whether intravenous haloperidol or chlorpromazine is more effective in improving agitation and communication in agitated delirium at the end of life.

Patients and methods: All terminally ill patients with delirium treated in 39 specialized palliative care services were enrolled via the web. Delirium diagnosis and severity (Delirium Rating Scale-revised-98) were evaluated at the start of treatment (T0) and 72 h later (T1), and the psychotropic drugs used concomitantly at T1 were investigated. We evaluated whether there was an improvement in DRS-R98 agitation-related item scores and DRS-R98 communication-related item scores at T1 in patients with agitated cancer who received intravenous haloperidol or chlorpromazine from T0, and whether a significant difference existed between the two groups.

Results: Of 818 enrolled participants, 424 experienced agitation at T0, comprising 183 in the haloperidol group and 68 in the chlorpromazine group. The concomitant benzodiazepine rates were 52% and 54% in the haloperidol and chlorpromazine groups, respectively. In both groups, improvement in DRS-R98 agitation item scores was observed at T1, but there was no significant difference in improvement between the two groups. Worsening in DRS-R98 communication item scores in both groups was observed at T1, but there was no significant difference in worsening scores between the two groups.

Conclusion: Intravenous haloperidol and chlorpromazine are not statistically different for terminal agitation. These results should be validated in clinical trials.