Delirium Clinical Pathway — CICU, PICU, and PCU

Pharmacological Therapy: Medication Interactions

Avoid concurrent use of metoclopramide with antipsychotic agents due to additive risk for EPS.
Use caution in patients at risk for prolonged QTc, or when using multiple QT-prolonging agents. Refer to CredibleMeds for a comprehensive list of QT-prolonging medications.
CYP450 Interactions:
- Common drug interactions that may be found in the ICU are included in this chart.
- Agents listed below are NOT indicative of all possible drug interactions.
Contact clinical pharmacy if assistance is needed assessing for clinically significant interactions.

		Inducers (↑metabolism)	Effect on Substrate		Recommendation
CYP	3A4	Commonly used ICU agents: Pentobarbital Phenobarbital Phenytoin Less common in the ICU: Bosentan, Carbamazepine/Oxcarbazepine, Rifampin	↓	Haloperidol Quetiapine	Wean off phenobarbital if being used for sedation and limit use of pentobarbital to avoid decreased substrate effects. Avoid inducing agents when possible, and note that dose requirements of the substrate may be increased where concurrent use is necessary.
CYP	2D6	Commonly used ICU agent: Phenobarbital Less common in the ICU: Carbamazepine/Oxcarbazepine, Rifampin	↓	Olanzapine

		Inhibitors (↓ metabolism)	Effect on Substrate		Recommendation
CYP	3A4	Commonly used ICU agents: Amiodarone Azole antifungals Lidocaine Macrolides Metronidazole Nicardipine Propofol Less common in ICU: Cyclosporine, Doxycycline, Quinidine, various selective serotonin reuptake inhibitors (SSRI’s)	↑	Haloperidol Quetiapine	Monitor for increased effects of substrate and consider slower up-titration if necessary.
	2D6	Commonly used ICU agents: Amiodarone Dexmedetomidine Lidocaine Methadone Nicardipine Less common in the ICU: Isoniazid, Quinidine, various selective serotonin reuptake inhibitors (SSRI’s)	↑	Haloperidol Risperidone
	1A2	Commonly used ICU agents: Ciprofloxacin Propofol	↑	Olanzapine

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