{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:06:49Z","timestamp":1781928409902,"version":"3.54.5"},"reference-count":32,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"3","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>   \n<jats:sec>\n<jats:title>Introduction<\/jats:title>\n<jats:p>Delirium affects nearly half of hospitalized older adults and is associated with prolonged hospitalization, dementia, and death. The behavioral manifestations of delirium are generally managed with antipsychotics, but there is growing interest in alternative medical therapy, including guanfacine.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This retrospective cohort study included patients \u226565 years of age admitted to Maine Medical Center between January 2021 and April 2023 and treated with guanfacine for delirium management on a non-ICU unit. Effectiveness outcomes included antipsychotic use and dose as well as a change in positive delirium screen after guanfacine initiation. Safety outcomes included incidence of hypotension, bradycardia, or transfer to ICU.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 56 patients who received at least 1 dose of guanfacine were evaluated, and 38 patients (68%) with complete data for days \u22121 to +2 were included in the effectiveness analysis. Before guanfacine initiation, 22\/38 patients (58%) were receiving an antipsychotic medication, compared with 18\/38 (47%) after guanfacine initiation (<jats:italic>p<\/jats:italic> = 0.86). Patients received a median (interquartile range) 6.4 (3.3 to 16) olanzapine equivalents (OE) before guanfacine was initiated and 4.2 (1.7 to 10.0) OE after guanfacine (absolute difference 2.2 OE; relative difference, 34 %; <jats:italic>p<\/jats:italic> = 0.8). All 56 patients were included in the safety analysis; 21 (38%) experienced hypotension, and of these, 7 (33%) patients required intervention. Twenty-three (41%) experienced bradycardia while on guanfacine, resulting in 1 patient being transferred to the ICU.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Discussion<\/jats:title>\n<jats:p>Upon initiation of guanfacine, patients with delirium had a reduction in daily antipsychotic exposure and a decrease in positive delirium screens. However, guanfacine was associated with hypotension and bradycardia.<\/jats:p>\n<\/jats:sec>","DOI":"10.9740\/mhc.2025.06.164","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T04:35:09Z","timestamp":1748838909000},"page":"164-9","source":"Crossref","is-referenced-by-count":1,"title":["Guanfacine for the management of the behavioral manifestations of delirium in older hospitalized adults"],"prefix":"10.9740","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7363-8629","authenticated-orcid":true,"given":"Kayla","family":"Garvey","sequence":"first","affiliation":[{"name":"Clinical Pharmacist, Maine Medical Center, Department of Pharmacy, Portland, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2857-6194","authenticated-orcid":true,"given":"Kobi","family":"Griffith","sequence":"additional","affiliation":[{"name":"Clinical Pharmacist, Maine Medical Center, Department of Pharmacy, Portland, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6061-9019","authenticated-orcid":true,"given":"Emily","family":"Carter","sequence":"additional","affiliation":[{"name":"Family Medicine and Geriatrics Medicine Doctor, Associate Director of Inpatient Programs, and Medical Director, Hospital Elder Life Program (HELP), Maine Medical Partners Geriatrics, Portland, Maine; Clinical Assistant Professor, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5533-6375","authenticated-orcid":true,"given":"Wendy","family":"Craig","sequence":"additional","affiliation":[{"name":"Research Assistant Professor, Tufts University School of Medicine, Boston, Massachusetts; Research Navigator, MaineHealth Institute for Research, Scarborough, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Pharmacist-Researcher, Maine Medical Center, Department of Pharmacy, Portland, Maine; Associate Professor of Medicine, Tufts University School of Medicine, Boston, Massachusetts; Faculty Scientist I, MaineHealth Institute for Research, Scarborough, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-6204","authenticated-orcid":true,"given":"Richard","family":"Riker","sequence":"additional","affiliation":[{"name":"Medical Director, Medical Critical Care, Maine Medical Center, Department of Critical Care, Portland, Maine; Professor, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1946-2849","authenticated-orcid":true,"given":"Nicolette","family":"Centanni","sequence":"additional","affiliation":[{"name":"(Corresponding Author) Clinical Pharmacist, Maine Medical Center, Department of Pharmacy, Portland, Maine, nicolette.centanni@mainehealth.org"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","reference":[{"issue":"15","key":"i2168-9709-15-3-164-b01","series-title":"N Engl J Med","first-page":"1456","article-title":"Delirium in hospitalized older adults","volume":"377","author":"Marcantonio","year":"2017","unstructured":"Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456-66. DOI: 10.1056\/NEJMcp1605501"},{"issue":"1","key":"i2168-9709-15-3-164-b02","series-title":"Arch Intern Med","first-page":"27","article-title":"One-year health care costs associated with delirium in the elderly population","volume":"168","author":"Leslie","year":"2008","unstructured":"Leslie DL,Marcantonio ER,Zhang Y,Leo-Summers L,Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27-32. DOI: 10.1001\/archinternmed.2007.4"},{"issue":"4","key":"i2168-9709-15-3-164-b03","series-title":"JAMA","first-page":"443","article-title":"Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis","volume":"304","author":"Witlox","year":"2010","unstructured":"Witlox J,Eurelings LS,de Jonghe JF,Kalisvaart KJ,Eikelenboom P,van Gool WA. 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