Abstract

The therapeutic benefit of melatonin in the prevention and treatment of delirium is uncertain. To perform a scoping study to describe the existing literature regarding the use of melatonin and ramelteon in the prevention and treatment of delirium. We performed a scoping study using the Arksey and O'Malley framework to explore our objective. Two independent panels searched MEDLINE, OVID, EMBASE, PubMed, Google Scholar, and Cochrane Library for relevant articles up to November 2017 describing the use of melatonin and ramelteon in the prevention or management of delirium. We extracted relevant summary data from the studies and attempted to draw conclusion regarding benefit. We summarized evidence from 20 relevant articles. There were a total of nine articles: five randomized controlled trials (RCTs), two retrospective medical record reviews, one non-randomized observational study, and one case report describing the role of either melatonin or ramelteon in preventing delirium. There were a total of 11 studies studying the role of either melatonin or ramelteon in the management of established delirium. None of these were RCT and were predominantly case series and case reports. Four of the five trials studying the effect of melatonin analogs in preventing delirium reported a beneficial effect but study heterogeneity limited any broad recommendations. Similarly, the lack of any well-designed trials limits any recommendations regarding the effect of melatonin analogs in treating delirium. Large, well-designed clinical trials are required to explore the potential beneficial effects of melatonin and ramelteon on delirium prevention and management.

Highlights

  • Delirium is defined as a transient change to attention and cognition that develops over a short period, is fluctuating in nature, and commonly involves disruption of the sleep–wake cycle (1, 2)

  • Our broad research question was “what is known from the existing literature about the use of melatonin and ramelteon in the prevention of and management of people with delirium?” within the scope of hospital inpatients over 50 years of age

  • There were 9 studies examining the role of melatonin or ramelteon in the prevention of delirium and 11 studies examining the role in delirium management

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Summary

Introduction

Delirium is defined as a transient change to attention and cognition that develops over a short period, is fluctuating in nature, and commonly involves disruption of the sleep–wake cycle (1, 2) It is a common condition affecting older people and is associated with significant mortality and morbidity (3). Pharmacological interventions to manage delirium include psychotropic medications such as antipsychotics and benzodiazepines Such medications are used commonly, despite the results of a recent systematic review not supporting their use in the treatment of delirium in older hospitalized adults (4). Benzodiazepines are sometimes used, especially in cases of benzodiazepine and alcohol withdrawal or when antipsychotics are contraindicated (5, 6) Both of these drugs classes are associated with an increased risk of substantial harm (such as oversedation and falls) and may prolong delirium duration (7–9).

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