From the Research
The best antipsychotic to use post bowel resection is typically quetiapine (Seroquel) at a starting dose of 25-50mg, which can be titrated as needed. This recommendation is based on the most recent and highest quality study available, which suggests that quetiapine may have a decreased hazard of in-hospital mortality compared to other antipsychotics such as haloperidol and olanzapine 1. The following key points support the use of quetiapine:
- Minimal anticholinergic effects and less impact on gastrointestinal motility compared to other antipsychotics, which is crucial after bowel surgery
- Can be titrated as needed to achieve the desired effect
- May have a decreased hazard of in-hospital mortality compared to other antipsychotics Some alternative options for patients who cannot take oral medications immediately after surgery include:
- Olanzapine (Zyprexa) in a rapidly dissolving tablet form (5-10mg)
- Haloperidol (Haldol) 0.5-2mg intramuscularly However, it's essential to note that these alternatives may have a higher risk of adverse effects, such as extrapyramidal symptoms, and should be used with caution 2, 1. The choice of antipsychotic should always be individualized based on the patient's psychiatric history, the extent of bowel resection, and potential drug interactions with other post-surgical medications. Close monitoring of bowel function is also crucial, as even these preferred medications can potentially affect gastrointestinal recovery. It's also important to use the lowest effective dose and monitor for side effects such as sedation, orthostatic hypotension, and QT prolongation 3, 1. Antipsychotics should be used cautiously in the post-operative period, primarily for managing delirium or continuing pre-existing psychiatric treatment. In summary, quetiapine is the preferred antipsychotic for use post bowel resection due to its favorable side effect profile and potential decreased hazard of in-hospital mortality.