Sigma-1 receptor agonist fluvoxamine for delirium in intensive care units: report of five cases

BACKGROUND Delirium is a highly prevalent disorder among older patients in intensive care units (ICUs). Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Drug treatment for delirium requires careful consideration of the balance between the effective management of symptoms and potential adverse effects. METHODS We report on five Japanese men (an 84 year old (acute aortic dissociation: Stanford type A), a 55 year old (traumatic subarachnoid hemorrhage and brain contusion), a 76 year old (sepsis by pyelonephritis), an 85 year old (cerebral infarction), and an 86 year old (pulmonary emphysema and severe pneumonia)) in which the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of the patients. RESULTS Delirium Rating Scale (DRS) scores in these five patients dramatically decreased after treatment with fluvoxamine. CONCLUSION Doctors should consider fluvoxamine as an alternative approach to treating delirium in ICU patients in order to avoid the risk of side effects and increased mortality from antipsychotic drugs.