• Hideyuki Nishiofuku, Masanori Mori, Naosuke Yokomichi, Yumi Sakuma, Koichi Sugiyama, Yoshiaki Takashina, Akemi Miyagi, Masato Ishizuka, Kengo Imai, and Tatsuya Morita.
• Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Nara, Japan.
• J Palliat Med. 2024 Aug 1; 27 (8): 109711011097-1101.

AbstractDelirium is a distressing condition in terminally ill cancer patients, often treated with antipsychotics. Administering them orally, subcutaneously, or intravenously can be challenging in severely agitated patients. Transdermal antipsychotic patches offer an alternative, but their use for terminal delirium remains underexplored. We present the case of a 73-year-old man with advanced diffuse large B cell lymphoma who developed severe mixed delirium during third-line chemotherapy. Nonpharmacological interventions and oral risperidone plus intravenous haloperidol failed to improve his condition. Subsequently, a transdermal blonanserin patch was applied, resulting in the resolution of hallucinations on day 1 and agitation on day 3, allowing improved communication. The patch was easily applied daily without notable adverse events. However, he deteriorated a week later with an estimated survival of days, ultimately requiring continuous midazolam for refractory agitation. This case underscores the potential of transdermal blonanserin patches for delirium in terminally ill cancer patients, emphasizing the need for future prospective studies.

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