Olanzapine vs haloperidol: treating delirium in a critical care setting

Objective: To compare the safety and estimate the response profile of olanzapine, a second-gen- eration antipsychotic, to haloperidol in the treatment of delirium in the critical care setting. Design: Prospective randomized trial Setting: Tertiary care university affiliated critical care unit. Patients: All ad- missions to a medical and surgical intensive care unit with a diagnosis of delirium. Interventions: Patients were randomized to receive either enteral olanzapine or haloperidol. Measure- ments: Patient's delirium severity and benzodiazepine use were monitored over 5 days after the diagnosis of delirium. Main results: Delirium In- dex decreased over time in both groups, as did the administered dose of benzodiazepines. Clinical im- provement was similar in both treat- ment arms. No side effects were noted in the olanzapine group, whereas the use of haloperidol was associated with extrapyramidal side effects. Conclusions: Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom haloperidol is con- traindicated.