Table 1 Delirium inducing drugs commonly used in palliative medicine610
OpioidsFor example, morphine, fentanyl, oxycodone. The risk of delirium associated with opioids is dose related
Anti-secretory medicationFor example, hyoscine hydrobromide (anticholinergic effect)
AnxiolyticsFor example, midazolam, diazepam, lorazepam
AntipsychoticsAntipsychotics, especially those with an anticholinergic effect, can induce delirium, and all traditional antipsychotic drugs confer an increased risk
Levomepromazine (methotrimeprazine/nozinan), a frequently used anti-emetic, has considerable anticholinergic properties and therefore presents a high risk of inducing delirium
Antidepressant drugsAll tricyclic antidepressant drugs exert an anticholinergic effect, with amitryptiline having the strongest and nortriptyline the weakest. The tricyclic antidepressants constitute a high risk group of drugs
AnticonvulsantsAll anticonvulsants have been reported to induce delirium, although the mechanisms are uncertain with probable differences between different drugs
SteroidsAdverse central nervous system (CNS) effects associated with corticosteroid treatment include delirium and chronic cognitive impairment, the risk being dose related
NSAIDsAll non-steroidal anti-inflammatory drugs (NSAIDs) have been reported to induce delirium
Gastrointestinal agentsAntispasmodics and H2 blockers
AntibioticsFluoroqinolones—for example, ciprofloxacin
AntihistaminesFirst generation—for example, diphenhydramine and chlorpheniramine