A prospective comparative study on naloxone combined haloperidol treatment for excited type delirium in elderly

Abstract

Objective Compared with haloperidol treatment, naloxone and naloxone combined haloperidol treatments were assessed in their efficacy and safety for excited type delirium in elderly. Methods The elderly patients with delirium were divided into haloperidol treatment (H), naloxone treatment (N) and combined treatment (C) in a prospective randomized controlled design. Delirium score scale (DSS) was used before and after treatments respectively. Clinical global impression scale-severity of illness (CGI-SI) score was evaluated daily to assess the onset time and improvement of delirium. Agitation-calmness evaluation scale (ACES) observed calmness effect in agitated patients before and after every medication intervention. Treatment emergent symptom scale (TESS) assessed side effects of all medications. Results The duration of three groups(H(4.0±2.9)d, N(4.2±3.5)d, C(3.2±3.2)d) had no significant difference (P>0.05) by multiple comparison. Compared the onset time of three groups (H(2.4±1.6)d, N(2.4 ±1.4)d, C(1.3±0.9) d), the combined group was faster than the other two groups ( all P 0.05). DSS scores had no significant differences (P>0.05) in three groups before treatment, so did CGI-SI scores. In the end, DSS scores were(H: 18.8±11.5, N: 27.7±7.2, C: 29.5±5.6)respectively. Statistically naloxone group and combined group with no significant difference (P>0.05), were better than the haloperidol group (all P 0.05). Three groups had no significant difference in ACES scores (P>0.05) before and after medication interventions(H: 5.9±1.6, N: 6.2±1.8, C: 6.4±1.6)(P>0.05). Haloperidol group had 4 cases of extrapyramidal symptom evaluated by TESS and combined group had 2 cases. Two groups had no significant difference (Chi-square test P>0.05) in extrapyramidal symptom incidence. The naloxone group showed no side effects. Conclusion Naloxone combined haloperidol is slight better than naloxone, more than haloperidol in terms of efficacy. Haloperidol equally with combined medication showed more side effects than naloxone. Key words: Naloxone; Haloperidol; Treatment; Delirium; Elderly patients