Delirium Following Topical Application of Compounded Creams Containing Multiple Analgesic Medications in Geriatric Patients: Two New Cases

Introduction Compounded topical formulations containing multiple classes of analgesic medications are becoming increasingly common; however, the current literature is sparse regarding complications such as delirium and inadvertent overdose in the elderly. Cases We describe two cases of geriatric patients who experienced acute delirium following use of compounded analgesic topical creams from the perspective of the psychiatry consultation team. Literature Review We found two case reports of adverse effects resulting from similar formulations in non-geriatric individuals. Age-related changes in skin and brain barrier function alter the pharmacokinetics of these medications, putting the geriatric population at higher risk. Discussion Topical medications carry many of the same systemic risks as those administered by other routes; however, they are often incorrectly assumed to be safer. This increases risk of inadvertent toxicity from overdose. Additional research is needed regarding the effects of topical analgesic medications, particularly in vulnerable populations.