January 02, 2020
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Ramelteon and suvorexant effective for delirium prevention

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Kotaro Hatta

Patients with delirium may benefit from taking ramelteon or Belsomra, according to results of a prospective observational study published in Journal of Clinical Psychiatry.

“Despite some success regarding the preventive effects of ramelteon and suvorexant on delirium in randomized placebo-controlled trials, no strong evidence regarding the effectiveness of these medications in real-world practice has been reported,” Kotaro Hatta, MD, PhD, of the department of psychiatry at Juntendo University Nerima Hospital in Tokyo, told Healio Psychiatry. “Melatonin receptor agonist ramelteon and orexin receptor antagonist suvorexant are not only effective but also safe, with few side effects.”

Hatta and colleagues explored the effectiveness of these medications for delirium prevention in real-world practice by recruiting trained psychiatrists at consultation-liaison psychiatric services to prescribe ramelteon and/or Belsomra (suvorexant, Merck) to patients aged 65 years or older who were hospitalized for elective surgery or acute diseases, had risk factors for delirium and had insomnia or delirium the night before a consultation. The researchers used incidence of delirium based on the DSM-V during the first 7 days as the primary outcome.

They reported that among 526 at-risk patients, those taking either or both medications were significantly less likely to develop delirium than those who were not. These outcomes remained after controlling for the effects of risk factors on the estimate of an independent association between the medications’ effects and the outcome of developing delirium (15.7% vs. 24%; OR = 0.48; 95% CI, 0.29-0.8), the researchers wrote. They found similar results among 422 patients with delirium (39.9% vs. 66.3%; OR = 0.36; 95% CI, 0.22-0.59).

“For patients at risk for and with delirium on the night before a consultation, ramelteon and suvorexant are viable considerations for delirium prevention,” Hatta said. “These findings open up a new and practical strategy of pharmacological prevention for delirium.” – by Joe Gramigna

Disclosures: Hatta reports receiving lecture honoraria from seven pharmaceutical companies, as well as serving as a consultant for Dainippon-Sumitomo, Merck Sharp & Dohme and Meiji Seika. Please see the study for all other authors’ relevant financial disclosures.