Lancet Healthy Longev
Trazodone shows safety advantage over antipsychotics in older adults with delirium
A nationwide cohort study emulating a target trial compared trazodone with atypical antipsychotics in adults ≥65 years treated for delirium. Among 11,678 trazodone users and nearly 29,590 antipsychotic users, trazodone was associated with 20% lower risk of rehospitalization for delirium, 16% lower risk of UTI, and 16% lower all‑cause mortality, with no significant differences in rates of falls, pneumonia, or stroke. Trazodone’s reduced rehospitalization risk remained consistent when compared with risperidone and olanzapine, whereas outcomes were similar when compared with quetiapine.
Clinical takeaway: When medication is deemed necessary for acute delirium in older hospitalized adults, trazodone may offer a safer alternative to antipsychotics, though it should be used conservatively and alongside non‑drug interventions.
Source:
Yang CT, et al. (2025, December). Lancet Healthy Longev. Safety outcomes of trazodone versus antipsychotics for delirium after hospital admission in adults aged 65 years and older: a nationwide cohort study using a target trial emulation framework. https://pubmed.ncbi.nlm.nih.gov/41448219/
