Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study
Background: Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium a...
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| Veröffentlicht in: | Journal of Nippon Medical School 2024/04/25, Vol.91(2), pp.233-240 |
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| creator | Nakajima-Ohyama, Kakusho Chigusa Shizusawa, Yoshie Uchiyama, Shotaro Kishi, Yasuhiro Tanimukai, Hitoshi |
| description | Background: Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. Results: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p |
| doi_str_mv | 10.1272/jnms.JNMS.2024_91-214 |
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Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. Results: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus. Conclusions: GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.</description><identifier>ISSN: 1345-4676</identifier><identifier>ISSN: 1347-3409</identifier><identifier>EISSN: 1347-3409</identifier><identifier>DOI: 10.1272/jnms.JNMS.2024_91-214</identifier><identifier>PMID: 38777784</identifier><language>eng</language><publisher>Japan: The Medical Association of Nippon Medical School</publisher><subject>Aged ; Aged, 80 and over ; delirium ; Delirium - drug therapy ; Female ; gabapentin ; Gabapentin - administration & dosage ; Gabapentin - adverse effects ; Gabapentin - therapeutic use ; gamma-Aminobutyric Acid - administration & dosage ; gamma-Aminobutyric Acid - adverse effects ; Humans ; Male ; Retrospective Studies ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of Nippon Medical School, 2024/04/25, Vol.91(2), pp.233-240</ispartof><rights>2024 by the Medical Association of Nippon Medical School</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c559t-9842772a83f108d774939344295ca269701d6c27a09c91a352f12ae78c75abdd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,1885,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38777784$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakajima-Ohyama, Kakusho Chigusa</creatorcontrib><creatorcontrib>Shizusawa, Yoshie</creatorcontrib><creatorcontrib>Uchiyama, Shotaro</creatorcontrib><creatorcontrib>Kishi, Yasuhiro</creatorcontrib><creatorcontrib>Tanimukai, Hitoshi</creatorcontrib><creatorcontrib>Department of Palliative Medicine</creatorcontrib><creatorcontrib>School of Human Health Sciences</creatorcontrib><creatorcontrib>Kyoto University</creatorcontrib><creatorcontrib>Department of Neuropsychiatry</creatorcontrib><creatorcontrib>Graduate School of Medicine</creatorcontrib><creatorcontrib>Nippon Medical School Musashi Kosugi Hospital</creatorcontrib><creatorcontrib>Osaka Gyoumeikan Hospital</creatorcontrib><creatorcontrib>Ikeda Municipal Hospital</creatorcontrib><title>Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study</title><title>Journal of Nippon Medical School</title><addtitle>J Nippon Med Sch</addtitle><description>Background: Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. Results: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus. Conclusions: GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>delirium</subject><subject>Delirium - drug therapy</subject><subject>Female</subject><subject>gabapentin</subject><subject>Gabapentin - administration & dosage</subject><subject>Gabapentin - adverse effects</subject><subject>Gabapentin - therapeutic use</subject><subject>gamma-Aminobutyric Acid - administration & dosage</subject><subject>gamma-Aminobutyric Acid - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1345-4676</issn><issn>1347-3409</issn><issn>1347-3409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkEtv1DAUhSMEog_4CSAv2WTqZxyzGxUYHoVKtF1bHueGJnKcqe0Uzb-v0wyzwItrSz7n3KOvKN4RvCJU0oveD3H1_dfPmxXFlGtFSkr4i-KUMC5LxrF6-fwWJa9kdVKcxdhjzJgQ1evihNUyn5qfFu4uQjs5DzGisUUbszU78KnzyERkPFq7BMGb1D3CxbrpJ28Tur2HYHZ71I4BfQLXhW4aPqI1-g0pjHEHdlaj622E8JidozcO3aSp2b8pXrXGRXh7uM-Luy-fby-_llfXm2-X66vSCqFSqWpOpaSmZi3BdSMlV0wxzqkS1tBKSUyaylJpsLKKGCZoS6gBWVspzLZp2HnxYcndhfFhgpj00EULzhkP4xQ1w0LRTELKLBWL1ObqMUCrd6EbTNhrgvUMWs-g9QxaH0DrDDr73h9WTNsBmqPrH9ks2CyC_NtZ40bvOg-6H6eM00Vt_5J-nKOfUzFWBFONCdOYsnlwzFnNhFI56ceS1Mdk_sBxlQmpsw6WgnOtefxf9Kiy9yZo8OwJwB2slA</recordid><startdate>20240425</startdate><enddate>20240425</enddate><creator>Nakajima-Ohyama, Kakusho Chigusa</creator><creator>Shizusawa, Yoshie</creator><creator>Uchiyama, Shotaro</creator><creator>Kishi, Yasuhiro</creator><creator>Tanimukai, Hitoshi</creator><general>The Medical Association of Nippon Medical School</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240425</creationdate><title>Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study</title><author>Nakajima-Ohyama, Kakusho Chigusa ; Shizusawa, Yoshie ; Uchiyama, Shotaro ; Kishi, Yasuhiro ; Tanimukai, Hitoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-9842772a83f108d774939344295ca269701d6c27a09c91a352f12ae78c75abdd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>delirium</topic><topic>Delirium - drug therapy</topic><topic>Female</topic><topic>gabapentin</topic><topic>Gabapentin - administration & dosage</topic><topic>Gabapentin - adverse effects</topic><topic>Gabapentin - therapeutic use</topic><topic>gamma-Aminobutyric Acid - administration & dosage</topic><topic>gamma-Aminobutyric Acid - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakajima-Ohyama, Kakusho Chigusa</creatorcontrib><creatorcontrib>Shizusawa, Yoshie</creatorcontrib><creatorcontrib>Uchiyama, Shotaro</creatorcontrib><creatorcontrib>Kishi, Yasuhiro</creatorcontrib><creatorcontrib>Tanimukai, Hitoshi</creatorcontrib><creatorcontrib>Department of Palliative Medicine</creatorcontrib><creatorcontrib>School of Human Health Sciences</creatorcontrib><creatorcontrib>Kyoto University</creatorcontrib><creatorcontrib>Department of Neuropsychiatry</creatorcontrib><creatorcontrib>Graduate School of Medicine</creatorcontrib><creatorcontrib>Nippon Medical School Musashi Kosugi Hospital</creatorcontrib><creatorcontrib>Osaka Gyoumeikan Hospital</creatorcontrib><creatorcontrib>Ikeda Municipal Hospital</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of Nippon Medical School</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakajima-Ohyama, Kakusho Chigusa</au><au>Shizusawa, Yoshie</au><au>Uchiyama, Shotaro</au><au>Kishi, Yasuhiro</au><au>Tanimukai, Hitoshi</au><aucorp>Department of Palliative Medicine</aucorp><aucorp>School of Human Health Sciences</aucorp><aucorp>Kyoto University</aucorp><aucorp>Department of Neuropsychiatry</aucorp><aucorp>Graduate School of Medicine</aucorp><aucorp>Nippon Medical School Musashi Kosugi Hospital</aucorp><aucorp>Osaka Gyoumeikan Hospital</aucorp><aucorp>Ikeda Municipal Hospital</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study</atitle><jtitle>Journal of Nippon Medical School</jtitle><addtitle>J Nippon Med Sch</addtitle><date>2024-04-25</date><risdate>2024</risdate><volume>91</volume><issue>2</issue><spage>233</spage><epage>240</epage><pages>233-240</pages><artnum>JNMS.2024_91-214</artnum><issn>1345-4676</issn><issn>1347-3409</issn><eissn>1347-3409</eissn><abstract>Background: Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. Results: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus. Conclusions: GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.</abstract><cop>Japan</cop><pub>The Medical Association of Nippon Medical School</pub><pmid>38777784</pmid><doi>10.1272/jnms.JNMS.2024_91-214</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over delirium Delirium - drug therapy Female gabapentin Gabapentin - administration & dosage Gabapentin - adverse effects Gabapentin - therapeutic use gamma-Aminobutyric Acid - administration & dosage gamma-Aminobutyric Acid - adverse effects Humans Male Retrospective Studies Time Factors Treatment Outcome |
| title | Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study |
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