Neuroleptics are commonly used for treating
delirium as a common problem in terminally ill
cancer patients. However, prescribing patterns are believed to substantially vary among health professionals. The aim of this study is to determine the pattern of prescribing
neuroleptics for treating
delirium in
cancer patients dying in a
palliative care unit in Saudi Arabia. We reviewed the medical records of adults with advanced
cancer who died in the
palliative care unit over 23 months. In addition to patients' demographics, data collection included the pattern of prescribing
neuroleptics for the treatment of
delirium during the last week of life. For the 271 patients included (57.6% females), the median age was 54 years. Although 62% of patients were on around-the-clock (ATC)
neuroleptics to treat
delirium, about two thirds of these were requiring rescue doses (PRN [pro re
nata]) as well. The ATC
neuroleptics included
haloperidol alone (89.3%),
levomepromazine alone (2.4%), or both (8.3%). All
neuroleptics were administered via the parenteral route. On average, the maximum daily doses of the ATC
neuroleptics were 4 mg for
haloperidol and 15.5 mg for
levomepromazine. Patients with primary or metastatic
brain cancers were less likely to be on
neuroleptics (P < .0001). The authors conclude that in their
palliative care unit,
haloperidol is by far the most commonly used
neuroleptic, followed by
levomepromazine, to treat the common problem of
delirium in patients dying with advanced
cancer. The generally low doses of
neuroleptics required may be attributed to several factors in this population, including cultural motives.