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Antipsychotic Options for Delirium-Related Agitation—A Multidisciplinary Practitioner Survey

Pharmacotherapy is a core component of delirium management. In the Greater Vancouver area, the first-generation antipsychotic, loxapine, is commonly used to treat delirium-related agitation. In early 2012, there was a Canada-wide shortage of injectable loxapine. We conducted an Internet-based survey of Greater Vancouver practitioners (physicians, nurses and pharmacists) regarding antipsychotic use for delirium-related agitation. Our main hypothesis was that the shortage of injectable loxapine necessitated significant changes to practice patterns in delirium management. The majority (59%) of practitioners believed that loxapine was the most commonly-used antipsychotic for management of deliriumrelated agitation at their hospital. Loxapine was the favored antipsychotic for management of delirium-related agitation in 61% of physicians, 41% of nurses, and 36% of pharmacists. Practitioners favoring loxapine were significantly more likely than others to indicate that the shortage of injectable loxapine resulted in a significant change to their management of delirium-related agitation. Our results suggest that practitioners who favor loxapine for delirium-related agitation were forced to make significant changes to their practice as a result of the injectable loxapine shortage. Furthermore, we identified an interesting disconnect between practitioner awareness of the pharmacotherapy evidence base and practitioner preferences in delirium management.