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Refractory hyperactive delirium in the dying: pharmacological management
  1. Kathryn Tham1,2,
  2. Angela Shiu1,3,
  3. Leeroy William1,2,4,
  4. Grace Walpole1,2 and
  5. Saly Rashed1,3
  1. 1 Supportive and Palliative Care Service, Wantirna Health, Wantirna, VIC, Australia
  2. 2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
  3. 3 Pharmacy Department, Eastern Health, Wantirna, VIC, Australia
  4. 4 Public Health Palliative Care Unit, Latrobe University, Melbourne, VIC, Australia
  1. Correspondence to Ms Angela Shiu, Wantirna Health, Wantirna, VIC 3152, Australia; angela.shiu{at}


Background Delirium is a prevalent clinical presentation in advanced illness. The hyperactive phase can cause severe symptoms at the end of life. There is no published study of the pharmacological management of this symptom in Australian palliative medicine practice.

Objectives To describe the pharmacological management of hyperactive delirium at the end of life in an Australian inpatient palliative care setting.

Methods Retrospective audit of deaths from October 2019 where a medication of interest (MOI) was used following admission to the palliative care unit (PCU) of Eastern Health. The clinical notes of those included were reviewed to further describe the clinical details surrounding the use of the MOI.

Results Forty patients were included. Midazolam was the most common medication used (57.5%). The most common dual agent combination was midazolam plus levomepromazine.

Conclusions This audit is the first description of pharmacological management of severe hyperactive delirium at the end of life requiring sedation in an Australian PCU.

  • delirium
  • pharmacology
  • symptoms and symptom management
  • terminal care

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  • Contributors KT performed and monitored the data collection, analysed the data, and drafted and revised the paper. She is guarantor. AS performed and monitored the data collection, analysed the data and drafted the paper. GW, LW and SR revised the draft paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.