Abstract
Background:
Delirium affects most patients with advanced cancer and is a major source of distress, especially in its hyperactive subtype. Pharmacologic options are limited for patients who cannot take oral medications.
Objectives:
To evaluate the effectiveness and safety of a transdermal blonanserin patch for managing hyperactive delirium in patients with advanced cancer admitted to a palliative care unit.
Design:
Retrospective observational study.
Settings/Subjects:
Consecutive patients with advanced cancer admitted to a palliative care unit in Japan between July 2023 and July 2025. Among 60 patients exhibiting agitation (Richmond Agitation–Sedation Scale–Palliative Version [RASS–PAL] ≥ +1), 21 received a 40-mg blonanserin patch. Eighteen patients who completed the 7-day assessment were analyzed.
Measurements:
The primary endpoint was the change in RASS–PAL score from day 0 to day 7. Safety events and the need for additional antipsychotics were recorded.
Results:
The median RASS-PAL score decreased from 2.0 to 0.5, and the mean score decreased from 1.9 to 0.6 (p = 0.0019). One patient developed reversible excessive sedation. No extrapyramidal symptoms, neuroleptic malignant syndrome, or cardiopulmonary events occurred. The median time from patch initiation to death was 24 days. Five patients required rescue antipsychotics, and no recurrence of the initial severity of delirium was observed.
Conclusions:
The transdermal blonanserin patch appears to be an effective and well-tolerated option for hyperactive delirium in patients with advanced cancer who cannot take oral antipsychotics. Larger prospective studies are warranted to confirm effectiveness and guide optimal use.
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