Anti-Delirium Drug May Harm Critically Ill
THURSDAY, Nov. 4 (HealthDay News) -- The anti-delirium drug
rivastigmine (brand name Exelon) does not appear to control
delirium in critically ill hospital patients, new Dutch research
When given to critically ill patients, it may even be linked to
a more severe type of delirium, a longer intensive care stay and
increased mortality, the new study suggests.
The findings could influence treatment protocols for the most
severely ill Alzheimer's and Parkinson's disease patients for whom
Exelon is a standard treatment.
In a news release, the Dutch team, led by Dr. Maarten M J van
Eijk and Dr. Arjen J.C. Slooter of the University Medical Centre in
Utrecht, concludes that "since (the) findings of our study show
that rivastigmine does not decrease duration of delirium and might
increase mortality in critically ill patients, we do not recommend
treatment of delirium with rivastigmine for patients in intensive
The authors present their analysis in the Nov. 5 online edition
Exelon is used to treat delirium among Alzheimer's and
Parkinson's patients at various stages of disease and overall
In particular, Exelon, which belongs to a class of drugs called
cholinesterase inhibitors, is a common treatment for patients
hospitalized in intensive care units, where the frequency of
delirium runs as high as 80 percent, the authors note.
Their findings stem from work with a little more than 100 Dutch
patients, aged 18 and up, who were being cared for in intensive
care units and were diagnosed with delirium.
Patients were given either twice daily doses of Exelon (at
between 1.5 mg and 6 mg a dose) or a sugar pill, in addition to
The authors found that the average length of delirium was three
days among those not taking Exelon and five days among those
getting the drug. In addition, the rate of death among the Exelon
group was higher than in the non-Exelon group, although the
difference was not deemed statistically significant.
The findings nevertheless raised sufficient concern that the
research team halted the investigation mid-stream, before inclusion
of another 350 or so patients slated for study participation.
Greg M. Cole, a neuroscientist with the Greater Los Angeles VA
Healthcare System and associate director of the Alzheimer's Disease
Research Center at the University of California, Los Angeles, David
Geffen School of Medicine, said the finding raises a host of
"There may be a lot of factors that could be affecting drug performance here," he noted. "You would want to know what it is specifically about these critically ill people that poses a problem. It is perhaps exposure to anesthesia while hospitalized, or is it a question of acute spiking infections or inflammation among a particularly frail and elderly group? The circumstances need to be carefully defined before we can be really sure what's at issue.
"But I would say that the study also has relevance to an audience that is even broader than just those who might be treated by this particular drug," Cole added. "Because the message here is that even for drugs that are widely used, it isn't usually one size fits all."
Even if a larger pool of people can be treated successfully with
this medication, it's important to know if it won't work with a
particular population, especially a group such as Alzheimer's
patients, he said.
For more on Exelon(rivastigmine), visit the
U.S. National Institutes of Health.
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