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Sanchez DL, Fusick AJ, Hudson WB, Schmitz JE, Catalano MC, Catalano G. Ramelteon in the Treatment of Delirium: New Perspectives from Reported Findings and a Case Observation. CURRENT DRUG THERAPY 2019. [DOI: 10.2174/1574885514666190308161421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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Ramelteon is a melatonin receptor agonist that is approved for the treatment of
insomnia. It is widely used due to its relatively benign side effect profile and lack of dependence
or withdrawal. Due to its tolerability, clinicians have attempted to utilize ramelteon
to normalize the sleep/wake patterns in patients with delirium as a safer alternative
to antipsychotics or other medications. We present the case of a 75-year-old man with
long-standing dementia who was hospitalized due to mental status changes, agitation, and
sleep disturbance. After addressing possible underlying causes with minimal improvement,
the team initiated treatment with ramelteon (8mg nightly) which resulted in rapid
improvement of symptoms. Uses and mechanisms of action of ramelteon will be reviewed,
as well as current pharmacologic treatments of delirium. Prior research studies
and case reports regarding the use of ramelteon in the treatment of delirium will be discussed
and suggestions made regarding possible areas of future study.
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Affiliation(s)
- Deborah L. Sanchez
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
| | - Adam J. Fusick
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - William B. Hudson
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Jourdan E. Schmitz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Maria C. Catalano
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Glenn Catalano
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
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Choy SW, Yeoh AC, Lee ZZ, Srikanth V, Moran C. Melatonin and the Prevention and Management of Delirium: A Scoping Study. Front Med (Lausanne) 2018; 4:242. [PMID: 29376051 PMCID: PMC5767075 DOI: 10.3389/fmed.2017.00242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022] Open
Abstract
Background The therapeutic benefit of melatonin in the prevention and treatment of delirium is uncertain. Objective To perform a scoping study to describe the existing literature regarding the use of melatonin and ramelteon in the prevention and treatment of delirium. Methods We performed a scoping study using the Arksey and O’Malley framework to explore our objective. Two independent panels searched MEDLINE, OVID, EMBASE, PubMed, Google Scholar, and Cochrane Library for relevant articles up to November 2017 describing the use of melatonin and ramelteon in the prevention or management of delirium. We extracted relevant summary data from the studies and attempted to draw conclusion regarding benefit. Results We summarized evidence from 20 relevant articles. There were a total of nine articles: five randomized controlled trials (RCTs), two retrospective medical record reviews, one non-randomized observational study, and one case report describing the role of either melatonin or ramelteon in preventing delirium. There were a total of 11 studies studying the role of either melatonin or ramelteon in the management of established delirium. None of these were RCT and were predominantly case series and case reports. Four of the five trials studying the effect of melatonin analogs in preventing delirium reported a beneficial effect but study heterogeneity limited any broad recommendations. Similarly, the lack of any well-designed trials limits any recommendations regarding the effect of melatonin analogs in treating delirium. Conclusion Large, well-designed clinical trials are required to explore the potential beneficial effects of melatonin and ramelteon on delirium prevention and management.
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Affiliation(s)
- Sin Wei Choy
- Department of Aged Care, Alfred Health, Melbourne, VIC, Australia.,Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Aun Chian Yeoh
- Department of Medicine, Peninsula Health, Frankston, VIC, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Zhao Zheng Lee
- Department of Medicine, Peninsula Health, Frankston, VIC, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Velandai Srikanth
- Department of Medicine, Peninsula Health, Frankston, VIC, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Chris Moran
- Department of Aged Care, Alfred Health, Melbourne, VIC, Australia.,Department of Medicine, Peninsula Health, Frankston, VIC, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
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Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies. Jundishapur J Nat Pharm Prod 2017. [DOI: 10.5812/jjnpp.64305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials. Mol Neurobiol 2015; 53:4046-4053. [DOI: 10.1007/s12035-015-9350-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/07/2015] [Indexed: 12/11/2022]
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Abstract
Purpose of review Our review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care. Recent findings Delirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation. Summary Although formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting.
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Yeh TC, Yeh CB, Tzeng NS, Mao WC. Adjunctive treatment with melatonin receptor agonists for older delirious patients with the sundowning phenomenon. J Psychiatry Neurosci 2015; 40:E25-6. [PMID: 25703643 PMCID: PMC4354823 DOI: 10.1503/jpn.140166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ta-Chuan Yeh
- The Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- The Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- The Department of Psychiatry, Tri-Service General Hospital, School of Medicine and the Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chung Mao
- The Department of Psychiatry, Tri-Service General Hospital, School of Medicine and the Institute of Brain Sciences, National Yang-Ming University, Taipei, Taiwan
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Chakraborti D, Tampi DJ, Tampi RR. Melatonin and melatonin agonist for delirium in the elderly patients. Am J Alzheimers Dis Other Demen 2015; 30:119-29. [PMID: 24946785 PMCID: PMC10852672 DOI: 10.1177/1533317514539379] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The objective of this review is to summarize the available data on the use of melatonin and melatonin agonist for the prevention and management of delirium in the elderly patients from randomized controlled trials (RCTs). A systematic search of 5 major databases PubMed, MEDLINE, PsychINFO, Embase, and Cochrane Library was conducted. This search yielded a total of 2 RCTs for melatonin. One study compared melatonin to midazolam, clonidine, and control groups for the prevention and management of delirium in individuals who were pre- and posthip post-hip arthroplasty. The other study compared melatonin to placebo for the prevention of delirium in older adults admitted to an inpatient internal medicine service. Data from these 2 studies indicate that melatonin may have some benefit in the prevention and management of delirium in older adults. However, there is no evidence that melatonin reduces the severity of delirium or has any effect on behaviors or functions in these individuals. Melatonin was well tolerated in these 2 studies. The search for a melatonin agonist for delirium in the elderly patients yielded 1 study of ramelteon. In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. Ramelteon was well tolerated in this study.
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Affiliation(s)
- Dwaipayan Chakraborti
- The Division of Gerontology, Geriatrics and Palliative Care, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Deena J Tampi
- Behavioral Health Service, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Rajesh R Tampi
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Adult Psychiatry Residency, Regional Academic Health Center, Harlingen, TX, USA
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Tsuda A, Nishimura K, Naganawa E, Otsubo T, Ishigooka J. Ramelteon for the treatment of delirium in elderly patients: a consecutive case series study. Int J Psychiatry Med 2014; 47:97-104. [PMID: 25084796 DOI: 10.2190/pm.47.2.a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Melatonin is effective in the prevention and treatment of delirium. Ramelteon has few adverse effects and higher affinity for MT1 and MT2 receptors than melatonin. The aim of the present study was to determine the efficacy of ramelteon in elderly patients with delirium caused by different primary diseases/conditions. METHOD We treated 10 consecutive elderly patients having delirium with ramelteon. RESULTS Of the 10 patients, six showed improvement, and no marked adverse effects were observed. CONCLUSIONS Our study suggested that ramelteon was a safe and useful alternative to melatonin for the treatment of delirium in elderly patients. Randomized, controlled studies are necessary to confirm the therapeutic benefits of ramelteon.
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Ogawa T, Iwai M, Hattori H, Zaitsu K, Kumazawa T, Ishii A, Suzuki O, Seno H. High-throughput analysis of ramelteon, agomelatine, and melatonin in human plasma by ultra-performance liquid chromatography–tandem mass spectrometry. Forensic Toxicol 2013. [DOI: 10.1007/s11419-013-0195-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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