Managing Agitated Delirium With Neuroleptics and Anti-Epileptics as a Neuroleptic Sparing Strategy

Inclusion Criteria:

1. \[Patients\] Diagnosis of advanced cancer (defined as locally advanced, metastatic recurrent, or incurable disease)
2. \[Patients\] Seen by palliative care inpatient consultation team
3. \[Patients\] Delirium as per DSM-5 criteria
4. \[Patients\] Hyperactive or mixed delirium with either a rescue medication order or any non-pharmacologic measures (e.g. sitter, restraints) for agitation, restlessness, or delirium
5. \[Patients\] Age 18 years or older
6. \[Patients\] Permission from clinician from primary team to enroll
7. \[Family Caregivers\] Patient's spouse, adult child, sibling, parent, other relative, or significant other (defined by the patient as a partner)
8. \[Family Caregivers\] Age 18 years or older

Exclusion Criteria:

1. \[Patients\] On scheduled haloperidol \>4 mg/d, chlorpromazine \>100 mg/d, or valproate \>750 mg/d
2. \[Patients\] History of myasthenia gravis, acute narrow-angle glaucoma, or hepatic encephalopathy as documented in chart
3. \[Patients\] Hepatic dysfunction (unresolved AST or ALT \>2.5x ULN, bilirubin \>1.5x ULN or INR \>1.5 within past month)
4. \[Patients\] History of neuroleptic malignant syndrome as documented in chart
5. \[Patients\] Active seizure disorder within past month as documented in chart
6. \[Patients\] History of Parkinson's disease or dementia as documented in chart
7. \[Patients\] History of prolonged QTc interval (\>500 ms) if documented by most recent ECG within the past month
8. \[Patients\] Hypersensitivity to haloperidol, chlorpromazine, or valproate as documented in chart
9. \[Patients\] Pancreatitis within past month as documented in chart
10. \[Patients\] Currently on lamotrigine, phenobarbital, or carbamazepine
11. \[Patients\] Physical signs of impending death such as respiration with mandibular movement and death rattle
12. \[Patients\] Pregnancy as documented in chart
13. \[Patients\] Active COVID-19 infection as documented in chart