Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ramelteon acts on a highly selective melatonin (MT1/MT2) receptor agonist. During delirium in postoperative and critically ill patients, a disruption of the sleep-wake cycle is frequently observed. Melatonin has a key role in the regulation of the sleep-wake cycle, so this raised the hypothesis that alterations in the metabolism of melatonin might play an important role in the development of delirium. Ramelteon and exogenous melatonin may have a prophylactic treatment for frail older persons at high risk for delirium that is safe, effective, and easily implementable in daily practice. However, there is currently insufficient evidence that ramelteon and exogenous melatonin is effective in preventing or treating postoperative delirium and sleep disorders in the critically ill patient.
 ...
PMID:[Delirium, insomnia in hospitalization and ramelteon]. 2262 20

A 68-year-old woman presented with a sudden severe headache, vomiting, and disturbed consciousness. She was admitted to the emergency room. Computed tomography (CT) revealed a hemorrhage in the right temporal lobe. Angiography demonstrated a ruptured aneurysm in the right middle cerebral artery (MCA) and an unruptured aneurysm in the left MCA. The subarachnoid hemorrhage was grade 3 (Hunt and Kosnik classification). Emergency craniotomy, clipping of the ruptured aneurysm and removal of the hematoma were performed. The left hemiparesis improved, and the patient was able to walk. We prescribed triazolam (0.25 mg/day) to treat the patient's insomnia. The unruptured aneurysm was additionally clipped on the 15th hospital day. After the second operation, the patient complained of delirium with restlessness, excitement, disorganized behavior, and sleep disturbance. Treatment with thiapride (150 mg/day) did not improve the delirium. We additionally administered Yi-gan san (7.5 g/day) and switched the triazolam to ramelteon (8 mg/day). The Memorial Delirium Assessment Scale score improved dramatically (from 16 at onset to 5 on day 7 and 1 at two months). Yi-gan san is reported to be effective for the treatment of behavioral and psychological symptoms of dementia. Ramelteon, a melatonin receptor agonist, is implicated in the regulation of the sleep-wake cycle. Ramelteon, unlike other hypnotic drugs, does not cause oversedation, rebound insomnia, withdrawal symptoms or dependence. In addition, we have noted no adverse effects, including oversedation or clinically significant changes in laboratory data, during combination therapy. A combination of ramelteon and Yi-gan san may therefore be beneficial in elderly patients with delirium, especially when there is a risk of oversedation.
...
PMID:[A combination of ramelteon and Yi-gan san successfully improved post-surgical delirium in a patient with subarachnoid hemorrhage]. 2404 72

The objective of this review is to summarize the available data on the use of melatonin and melatonin agonist for the prevention and management of delirium in the elderly patients from randomized controlled trials (RCTs). A systematic search of 5 major databases PubMed, MEDLINE, PsychINFO, Embase, and Cochrane Library was conducted. This search yielded a total of 2 RCTs for melatonin. One study compared melatonin to midazolam, clonidine, and control groups for the prevention and management of delirium in individuals who were pre- and posthip post-hip arthroplasty. The other study compared melatonin to placebo for the prevention of delirium in older adults admitted to an inpatient internal medicine service. Data from these 2 studies indicate that melatonin may have some benefit in the prevention and management of delirium in older adults. However, there is no evidence that melatonin reduces the severity of delirium or has any effect on behaviors or functions in these individuals. Melatonin was well tolerated in these 2 studies. The search for a melatonin agonist for delirium in the elderly patients yielded 1 study of ramelteon. In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. Ramelteon was well tolerated in this study.
 ...
PMID:Melatonin and melatonin agonist for delirium in the elderly patients. 2494 85