Trazodone for delirium is getting attention for a reason. Delirium is often described as a sudden state of confusion that affects older adults during or after hospitalization. It can be frightening for everyone involved. Residents may be confused, acting out, inconsolable, and at risk for injury. Treatment for delirium in acute care has long included antipsychotic medications. However, the safety and efficacy of these medications remain unclear. A recent study published in The Lancet Healthy Longevity found that patients treated with trazodone had a lower risk of death and were less likely to be re-hospitalized than those receiving antipsychotic medications.

Delirium is a common and concerning clinical syndrome in adults age 50 and older who are admitted to the hospital. Symptoms may persist until discharge and sometimes for months afterward. Clinical guidelines recommend non-pharmacological interventions as the first-line approach. Medications should be reserved for situations where de-escalation strategies have failed. Contributing factors should also be addressed first. Drug therapy is generally considered when symptoms cause distress or create a risk of harm to the resident or others.

So, what is trazodone? It is an antidepressant. However, it is often prescribed off label at low doses to help with sleep. There are several important considerations. Regulatory surveyors do not favor medications used solely for sleep. If trazodone is used for delirium, the documentation should clearly explain the rationale for off-label use. This medication may also cause daytime drowsiness, even at low doses. It can lower blood pressure and lead to dizziness in older adults. These side effects may increase the risk of falls.

The bottom line is that trazodone for delirium may offer benefits. Residents still need close monitoring for side effects. The findings are encouraging, but more research is needed to confirm efficacy and safety. First do no harm.

Stay well and stay informed!