Drug-induced Delirium: A Frequent and Important Matter for Geriatricians

Use and abuse of drugs, especially if inappropriate, are among the most frequent causes of delirium in elderly people. This article describes an interesting case report on drug-induced delirium in a 74-year-old woman taking several drugs. She was hospitalised for fall and functional inability to lower limbs. She was affected with hypertension, depression and she had undergone surgery and radiotherapy for breast cancer. She had been complaining cognitive impairment for 2 years. Patient was treated with amlodipine 5 mg, ramipril 5 mg, aspirin 100 mg, chlorimipramine 25 mg twice a day. Brain CT scan and spine MRI pointed out multiple dorsolumbar herniated discs. She was visited by a medical doctor who was a specialist in pain treatment; he prescribed oxycodone/naloxone 5/2.5 mg twice/day. After discharge she complained persistent pain, the specialist in pain treatment increased oxycodone/naloxone 5/2.5 mg up to 3 times daily. After 1 week, patient suddenly presented hyperactive delirium. She underwent geriatric consulting; tricyclic drug and opioid analgesics were interrupted and started oral haloperidol 1.5 mg and intramuscular citicoline 1000 mg. After 3 days, symptoms had disappeared and patient gradually recovered. The present case report is a typical example of drug-induced delirium. Geriatric competence is closely required when one needs to examine the possible interference among drugs in poly-treated patients affected with several diseases, or for example when a drug is used in this group of patients but is strictly contraindicated.