Blonanserin transdermal patch for treating delirium: A case series

Aim: Antipsychotics are commonly recommended for the treatment of delirium; however, alternative options are warranted due to the limitations of oral and injectable formulations. The blonanserin (BNS) transdermal patch may improve treatment adherence; however, evidence regarding its efficacy in managing delirium remains limited. Methods: This retrospective case series describes 51 cases of delirium managed with BNS patches at Kyoto University Hospital between January 2020 and June 2022. The effectiveness of the BNS patch for delirium, the rationale for its selection, and the associated adverse events were retrospectively evaluated using electronic medical records. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria by physicians from the consultation-liaison or palliative care teams, and the symptoms were regularly monitored. Effectiveness was assessed based on non-standardized clinical judgment documented in the medical records. Results: Hyperactive and mixed delirium were observed in 41.2% and 56.9% of patients, respectively. Overall, the therapeutic response rate across all patients was 84.3%. The main reasons for the selection of BNS patches were difficulty or inability to take oral medications (60.8%). Adverse events occurred in 29.4% of patients; all resolved after discontinuation of the BNS patch, and no serious or irreversible reactions were observed. Conclusion: These findings indicate that the BNS patch has potential as an effective treatment option for delirium, particularly in patients with challenges in the administration of medication. However, given the retrospective and exploratory nature of this study, the findings should be interpreted with caution.