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July 14, 2004

Pharmacological Treatment of Delirium in the Intensive Care Unit—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292(2):168. doi:10.1001/jama.292.2.168-b

In Reply: We agree with Dr Frankenburg that both typical and atypical/second generation antipsychotic agents should be studied in double-blind, controlled trials. While haloperidol is the current drug of choice for delirium, as we mentioned, neither this medication nor any other carries an indication from the US Food and Drug Administration for delirium. In fact, no placebo-controlled trials have documented that antipsychotic agents reduce the severity and duration of delirium, much less improve long-term clinical outcomes. Nevertheless, 70% of 912 clinicians reported in our recent survey that they use antipsychotic agents as their primary medical therapy for delirium in the ICU.1