Mianserin suppositories in the treatment of post-operative delirium

Mianserin suppositories (10–90 mg) were administered at bedtime to 16 patients with post-operative delirium (mean age 69·5 years). By the Delirium Rating Scale (DRS: Trzepacz et al., 1988), the average score decreased from 21·2 prior to administration to 14·5 on the first day of treatment and to 7·1 on the seventh day. Improvement was observed in all cases (marked in 85 per cent and slight in 15 per cent). The plasma concentration of mianserin was 65 ng/ml on day 1, 93 ng/ml on day 3 and 65 ng/ml on day 5, having reached therapeutic levels within 24 h of beginning treatment. Decreases in the free-3-methoxy-4-hydroxyphenyl(ethylene)glycol (MHPG) concentrations in plasma were observed after drug administration, but free-homovanillic acid (HVA) concentrations in plasma showed no significant change with the drug treatment. We consider mianserin suppositories to be an effective treatment for post-operative delirium. © 1997 John Wiley & Sons, Ltd.