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Drugs that can Cause ( / toxic metabolites)

Deliriants ( causing delirium)

Prescription drugs

. Central acting agents – (e.g., ) – (e.g., ) – Antiparkinsonian agents (e.g., benztropine, ) . (NB. meperidine*) – Non-steroidal anti-inflammatory drugs* . (first generation, e.g., ) . Gastrointestinal agents – – H2-blockers* . Antinauseants – . – Fluoroquinolones* . Psychotropic * . Cardiac medications – Antiarrhythmics – Digitalis* – Antihypertensives (b-blockers, ) . Miscellaneous – relaxants –

Over the counter medications and complementary/alternative medications

. Antihistamines (NB. first generation) – , chlorpheniramine). . Antinauseants – dimenhydrinate, scopolamine . Liquid medications containing . . Henbane . Jimson . belladonna extract

* Requires adjustment in renal impairment.

From: K Alagiakrishnan, C A Wiens. (2004). An approach to induced delirium in the elderly. Postgrad Med J, 80, 388–393.

Delirium in the Older Person: A Medical Emergency. Island Health www.viha.ca/mhas/resources/delirium/ Drugs that can cause delirium. Reviewed: 8-2014

Some commonly used medications with moderate to high anticholinergic and alternative suggestions

Type of Alternatives with less deliriogenic risk

Antidepressant , SSRI, TCA (secondary amine) (e.g., TCA, tertiary) Second generation antihistamine (e.g., diphenhydramine) (e.g., ) Antiparkinsonian Levodopa (e.g., benztropine, trihexyphenidyl)

Gastrointestinal agents, e.g., (A) , (B) Dimenhydrinate Proton pump inhibitor (e.g., ) Low , (e.g., , thioridazone)

SSRI, selective inhibitor; TCA, tricyclic .

From: K Alagiakrishnan, C A Wiens. (2004). An approach to drug induced delirium in the elderly. Postgrad Med J, 80, 388–393.

Delirium in the Older Person: A Medical Emergency. Island Health www.viha.ca/mhas/resources/delirium/ Drugs that can cause delirium. Reviewed: 8-2014

Symptoms of an anticholinergic drug reaction

Physical Symptoms Cognitive Symptoms

. Blurred vision . / clouding of . Hot, dry skin / dehydration . Memory impairment . Dry mouth . Visual . Shortness of breath . Sensory illusions . Dilated . Disturbance in -wake cycle . Increased heart rate . Disorientation, especially to time and . Increased / decreased psychomotor place activity . Incoherent speech . . , agitation, excitement . Urinary incontinence . Hyperpyrexia

Delirium in the Older Person: A Medical Emergency. Island Health www.viha.ca/mhas/resources/delirium/ Drugs that can cause delirium. Reviewed: 8-2014