Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles. Overall, antipsychotics don’t reverse the underlying pathophysiologic causes of delirium. However, antipsychotics can be useful to alleviate symptoms of agitation and insomnia, allowing the patient to be managed safely while delirium abates. Most classes of neuroactive medications have a consistent mechanism of action (e.g. benzodiazepines, barbiturates, SSRIs). Uniform pharmacodynamics within a class of drugs allows knowledge about one drug to be applied to other drugs within the same class. For example, if lorazepam works for seizure and your department runs out of lorazepam, then it’s a fair assumption that another benzodiazepine would work as well.

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