Delirium Clinical Pathway — CICU, PICU, and PCU

Trial of Pharmacological Therapy: Common Side Effects and Adverse Drug Event Management

Common Side Effects

Known common side effects of these medications include, but are not limited to: hypertension, increased cholesterol/triglycerides, increased liver enzymes, dyskinesias, dry mouth, lethargy, akathisia, hypertonia, extrapyramidal symptoms (EPS), restless leg syndrome, and increased weight gain (with long-term use).

Known serious, but less common, side effects of these medications include, but are not limited to: QTc prolongation, neutropenia, leukopenia, thrombocytopenia, neuroleptic malignant syndrome (NMS), seizures, tardive dyskinesia, and allergic reactions.

See AACAP Practice Parameters for Atypical Antipsychotic Medications for more guidance on EPS and NMS.

Adverse Drug Event Management

Discontinue antipsychotic medication as soon as possible if adverse drug event is noted

Adverse event	Recommendations
QTc > 500 ms OR QTc increase by > 60 ms	> 500 ms: Discontinue antipsychotic agent and consult Cardiology to weigh risks and benefits of resuming at 50% of the previous dose
QTc increased by > 30 ms	Discuss risks versus benefits and consider decreasing antipsychotic dose by 50%
Muscle stiffness or abnormal/involuntary movement problems	Give diphenhydramine 1 mg/kg/dose PO/IM/IV (max 50 mg)
Persistent movement symptoms	Consider 2nd dose of diphenhydramine Consider benztropine 0.05 mg/kg/dose for children > 3 years of age (not recommended for children < 3 due to serious adverse events)

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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