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A case report of the efficacy and usefulness of asenapine in the treatment of a cancer patient with delirium and aphagia

Published online by Cambridge University Press:  26 December 2018

Kyoko Osawa ,
Satoshi Ukai  and
Toshiyuki Kuriyama
Kyoko Osawa*
Affiliation:
Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan Department of Palliative Medicine, Wakayama Medical University Hospital Oncology Center, Wakayama, Japan
Satoshi Ukai
Affiliation:
Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
Toshiyuki Kuriyama
Affiliation:
Department of Palliative Medicine, Wakayama Medical University Hospital Oncology Center, Wakayama, Japan Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
*
Author for correspondence: Kyoko Osawa, M.D., Ph.D., Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509Japan. E-mail: osawa@wakayama-med.ac.jp
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Abstract

Objective

Controlling hyperactive and mixed delirium is extremely important for the continuation of cancer treatment in palliative care. In general, oral antipsychotics are the first-line drug therapy for delirium; however, oral administration is problematic in patients presenting dysphagia. In this case report, we describe an end-stage cancer patient with aphagia who developed delirium and responded to sublingual antipsychotic asenapine for treating delirium. We also discuss the effectiveness of asenapine in hyperactive delirium as well as its usefulness for treating delirium in palliative care.

Method

A cancer patient with delirium was treated with several oral antipsychotics commonly used to treat delirium but did not respond to any of them. The patient subsequently developed aphagia with progression of the disease. Sublingual asenapine was therefore given to treat delirium.

Result

Asenapine was effective in treating delirium without causing any obvious side effects.

Significance of results

In the present case, asenapine was effective in treating hyperactive delirium that did not respond to commonly used antipsychotics. Because asenapine is a sublingual tablet, it can be used in patients with dysphagia and aphagia. In addition, this drug is anticipated to diminish the burden of end-stage patients from taking oral medications. Furthermore, its management is easier compared with injections, and can therefore also be easily used in homecare patients. Based on these perspectives, asenapine may become an important option for treating delirium in palliative care.

Keywords

Palliative careDeliriumDysphagiaAsenapineSublingual administration
Type
Case Report
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 488 - 491
Copyright
Copyright © Cambridge University Press 2018 

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