An 85-year-old woman admitted with pneumonia develops severe agitation and hallucinations consistent with delirium. She is pulling out her IV line and endangering herself. Non-pharmacological measures have failed. Which agent is the most appropriate first-line choice?

• A Lorazepam 1 mg IV
• B Low-dose haloperidol ✓
• C Zolpidem 10 mg orally
• D Diazepam 5 mg orally

Explanation

When pharmacological treatment of delirium is required, a low dose of a high-potency antipsychotic such as haloperidol is the conventional first-line agent because it controls agitation with minimal anticholinergic and sedative load. Benzodiazepines such as lorazepam and diazepam worsen delirium through sedation and disorientation and are reserved for withdrawal states. Zolpidem is a hypnotic with no role in treating agitated delirium and increases fall risk.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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