Comparison and analysis of delirium induced by histamine H 2 Receptor antagonists and proton pump inhibitors in cancer patients

Abstract

Objective: H 2 blockers have been reported to be responsible for drug-induced delirium. We compared the incidence of delirium between two groups of patients who were treated with H 2 blockers (H 2 group) or proton pump inhibitors (PPI group) for anastomotic ulcer prevention following surgical treatment of esophageal cancer. Method: The incidence and severity of delirium were retrospectively compared in patients of the H 2 group (30 cases; age, 65.2 ± 8.1 years) and the PPI group (30 cases; 65.2 ± 6.5 years). The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. Delirium severity was rated on the Delirium Rating Scale (DRS). Results: The incidence of delirium was significantly lower in the PPI group than in the H 2 group (p = 0.047). In the 11 patients from the H 2 group who developed delirium, discontinuation of H 2 blockers resulted in a significant reduction in the DRS score (p = 0.009). In three patients for whom H 2 blockers were discontinued, DRS scores decreased by 50% or more three days after discontinuation compared to the prediscontinuation score. Conclusions: These results suggested that switching antiulcer drugs from H 2 blockers to PPIs reduced delirium and thus provided an appropriate coping method for drug-induced delirium from antiulcer drugs. Copyright © 2012 S. Karger AG, Basel.