Proper use of tiapride hydrochloride in the treatment of delirium in patients undergoing hemodialysis in an inpatient setting

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  • Shima Yuko
    Department of Pharmacy, Asanagi Hospital
  • Hirata Sumio
    Center for Clinical Pharmaceutical Sciences and Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University School of Pharmacy
  • Sano Takahiro
    Hemodialysis Center, Asanagi Hospital
  • Tanabe Tomoko
    Department of Pharmacy, Asanagi Hospital
  • Tuji Akiko
    Department of Pharmacy, Asanagi Hospital
  • Okuda Kouji
    Department of Cardiovascular Medicine, Asanagi Hospital
  • Kuroda Masahiro
    Department of Nephrology, Asanagi Hospital

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Other Title
  • 入院血液透析患者のせん妄治療におけるチアプリド塩酸塩の適正使用
  • ニュウイン ケツエキ トウセキ カンジャ ノ センモウチリョウ ニ オケル チアプリド エンサンエン ノ テキセイ シヨウ

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<p>Because a large fraction of tiapride hydrochloride (tiapride) used to treat delirium and agitation is excreted unchanged in the urine, the dosage of tiapride should be reduced in patients with renal impairment or those undergoing hemodialysis (HD). The overdosing of tiapride results in oversedation and drowsiness as well as extrapyramidal symptoms due to its antidopaminergic action. Although 25 mg of tiapride, 1 to 2 times daily, is recommended for elderly individuals, its application in HD patients has not been specified. In this study, we therefore investigated the actual clinical application of tiapride to reveal its efficacy and safety. Subjects were 32 HD patients who were treated with tiapride for delirium in an inpatient setting between April 2002 and August 2012. As in elderly individuals, tiapride was highly effective and had a rapid onset of action in HD patients. However, 3 patients who received a single 25 mg dose were nonresponsive. Adverse reactions were observed in 7 of the 32 HD patients (≥5 on the Naranjo Adverse Drug Reaction [ADR] scale). The ADR group (n=7) was compared with the non-ADR group (n=25). The incidence of adverse reaction was significantly higher in patients who were given ≥37.5 mg/day of tiapride than in those given ≤25 mg/day (P<0.0001). In addition, the incidence of adverse reaction was more notable in patients given 0.6 mg/kg/day of tiapride than in those given ≤0.5 mg/kg/day (P=0.0049). Furthermore, a comparison of patients who had an early (≤3 days) and late (≥4 days) drug effect revealed that patients with an early effect had a higher incidence of adverse reactions (P=0.044). Some patients with adverse reactions were concurrently taking antipsychotics or anxiolytics, suggesting the synergy of concurrent medication on adverse reactions. The onset of drug action is early when used at 37.5 mg daily, and although it may be effective as a loading dose, we recommend ≤25 mg tiapride daily as a maintenance dose and ≤0.5 mg/kg/day to be safe. However, examination of a greater number of patients is needed to verify the efficacy and safety of tiapride.</p>

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