Original Research J Clin Psychiatry January 2025

Effects of Intravenous Hydroxyzine Versus Haloperidol Monotherapy for Delirium: A Retrospective Study

JCP 2025;86(1):10.4088/JCP.24m15569

Full Article Read the complete peer-reviewed article in J Clin Psychiatry. Clinical Summary Delirium is common in hospitalized older adults, and the standard pharmacologic fallback—antipsychotics—carries risks that matter most in the very patients who often need treatment, including extrapyramidal symptoms, QT prolongation, and increased mortality in elderly patients and those with dementia. This study asks a practical inpatient question: when oral treatment is not feasible, can intravenous hydroxyzine perform as well as or better than intravenous haloperidol for delirium? FAQ What did this study find about intravenous hydroxyzine compared with intravenous haloperidol for delirium?

Key Takeaways This analysis focused on a highly selected monotherapy cohort: only 71 (1.3%) hydroxyzine-treated patients and 82 (1.5%) haloperidol-treated patients met eligibility criteria out of 5,555 patients who developed delirium, so these findings apply most directly when other delirium agents are not being given concurrently. Clinical Guide How should clinicians and inpatient teams identify hospitalized patients who need structured delirium surveillance? Clinical Guide How should clinicians decide when intravenous hydroxyzine monotherapy is a reasonable alternative to intravenous haloperidol for delirium?