When delirium is comorbid with other psychiatric disorders, the delirium should be treated first and the treatments for these other disorders, such as antidepressant or anxiolytic medications, should be minimized or not begun until the delirium is resolved. Medications for psychiatric disorders can both be the cause of delirium and exacerbate or contribute to delirium from other causes. B. Comorbid General Medical Conditions 1. The liver is the body's detoxifying organ for drugs and other molecules. Hepatic insufficiency significantly affects the metabolism of many medications.
Most psychotropic medications undergo hepatic transformation.
In addition, the liver produces albumin and other plasma proteins that transport bound medications in the bloodstream. Thus, the former effect may alter therapeutic effects or cause side effects, while the latter may result in less therapeutic effect than expected at a given dose. Haloperidol undergoes metabolism by the P450 2D6 enzyme system, which reduces it to reduced haloperidol. The latter is in equilibrium with the parent drug. This suggests that its pharmacokinetics in patients with liver insufficiency would be similar to those in other patients when used to treat delirium.