Sleep (PRN)
| Generic | Brand | Route | Dose | Notes |
|---|---|---|---|---|
| Zolpidem | Stilnox | PO | 5–10 mg nocte | Z-drug; short-term only |
| Melatonin | – | PO | 2 mg nocte | Preferred in elderly / delirium risk |
Approach to agitation
1. Assess and address the cause. Delirium is a symptom: infection, pain, constipation, urinary retention, medication, metabolic derangement.
2. Non-pharmacological first. Reorientation, lighting, hearing aids/glasses, family presence, sleep hygiene, mobilization.
3. Medication only when de-escalation tried, contributing factors addressed, and patient has severe distress or agitation posing a safety risk.
- Parkinson disease / Lewy body dementia: avoid haloperidol and other potent D2 blockers (high sensitivity). Seek senior/specialist advice if medication required
- Alcohol / benzodiazepine withdrawal: benzodiazepine-based treatment, not antipsychotics (do not prevent seizures or DT progression)
- Antipsychotics do not treat or shorten delirium (APA 2024). May help manage severe agitation when other measures fail. Lowest effective dose, shortest duration; monitor QT and EPS
Acute agitation / sedation
| Generic | Brand | Route | Dose | Notes |
|---|---|---|---|---|
| Haloperidol | Haldol | PO / IM / IV | 0.5–2 mg, repeat cautiously | Severe agitation; QT, EPS; avoid in Parkinson’s / Lewy body |
| Lorazepam | Ativan | PO / IM / IV | 0.5–1 mg | Agitation, alcohol withdrawal, seizures |
| Diazepam | Valium | PO / IV / PR | 2–10 mg | Seizures, alcohol withdrawal; long-acting |
| Midazolam | Dormicum | IV / IM / buccal | 2–5 mg IV titrated; 10 mg buccal | Short-acting; respiratory depression: monitor |
Benzodiazepines can worsen delirium outside withdrawal contexts (see approach above).
Educational reference for clinicians. Doses are typical adult starting points. Cross-check allergies, interactions, current local policy, the formulary, and renal/hepatic function before prescribing.
Last updated · August 2026