haloperidol (Haldol)Drug information provided by: Haldol side effects in elderly deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your effectx if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
When is Haldol the Right Choice?
Haloperidol, frequently used for delirium, can lead to serious side effects, of which QTc prolongation is the most worrisome since it is associated with an increased risk of fatal cardiac arrhythmia. A total of procedures took place in elderly patients, and patients were readmitted for a second procedure in the same year.
The overall frequency of haloperidol use was 5. Patients receiving haloperidol had a significantly longer hospital stay 14 vs. Haloperidol users were more likely to have more than one intervention than non-users We show a frequency of haloperidol use of 5. Based on this high frequency, surveillance of adverse events in hospital should be performed systematically, particularly in the high-risk population that undergoes acute major surgery.
In , the US FDA warned clinicians against prescribing antipsychotic medications to patients with dementia-related psychosis, because it would expose patients to an increased risk of death [ 1 ]. Known immediate side effects of antipsychotics include somnolence, urinary tract infection, urinary incontinence, extrapyramidal symptoms, or abnormal gait [ 3 — 6 ].
Antipsychotics are prescribed for many different symptoms and diseases, such as anxiety, psychosis due to schizophrenic disease or depression, and behavioral disturbance in dementia or delirium. Hospitalized patients with delirium may have a similar or even higher potential for adverse side effects from antipsychotics than more stable patients.
The most important known risk factors for postoperative delirium are older age and cognitive or functional impairment [ 7 ]. Many older patients with delirium also have dementia; they also usually have an acute medical illness and multiple comorbidities, and are often taking drugs that increase the QTc interval. Yet this issue remains unaddressed, because no published, adequately powered, double-blind, randomized, placebo-controlled trials have examined the safety of antipsychotics in the management of delirium [ 8 ].
In addition, no specific recommendations exist for patients with delirium as well as dementia. The scientific evidence for the efficacy of haloperidol in treating delirium is based on a few studies [ 10 ].
Five studies evaluated the side effects of haloperidol versus various neuroleptics e. The UK National Institute for Health and Care Excellence NICE guideline on delirium, which took into account the evidence available at that time, advised limiting the use of antipsychotics for individuals with delirium in distress or at risk to themselves or others.
Furthermore, it should be prescribed only after non-pharmacological interventions have been tried, and then only in the lowest possible dose and for the shortest possible time period [ 16 ].
A prerequisite for assessing the risks associated with antipsychotic use in hospitalized patients is to have systems that record the use of these drugs. We studied haloperidol because it is the first-choice medication for delirium in the Netherlands [ 17 ]. This hospital has beds and is a non-academic, regional teaching hospital with 21 separate medical training specialties.
The surgical specialties were gynecology, orthopedics, general surgery, urology, ophthalmology, otorhinolaryngology, oral surgery, neurosurgery, and plastic or reconstructive surgery. Haloperidol administration during admission was identified using the electronic hospital drug database. Procedures were categorized as either acute or elective based on the reason for admission, as classified by the International Statistical Classification of Diseases and Related Health Problems — 9th revision ICD We used t -tests and Mann—Whitney U tests to test for differences in characteristics in patients with and without haloperidol use.
Variables that were not normally distributed were expressed as median scores and interquartile ranges. We performed univariate and multivariate logistic regression analyses, where haloperidol use was the dependent variable, and age, acute versus elective surgery, minor versus major procedures, and surgical specialty were the independent variables. A total of procedures occurred in patients; patients underwent a second procedure during their first admission, and patients were admitted for at least one additional procedure in the same year.
The overall incidence of haloperidol use related to the first procedure in the first admission was 5. Those administered haloperidol were significantly older Patients who received haloperidol had a significantly longer hospital stay 14 vs.
Haloperidol users more often underwent more than one procedure e. These were classified as minor procedures, with a haloperidol usage of 0.
Haloperidol use in patients admitted with a fracture was acute: Haloperidol use in orthopedics was 6. The hospital is representative of large teaching hospitals in the Netherlands. Haloperidol use in acute and major surgery was much higher than in elective and minor surgery; at least one-quarter of patients who fell into either category received this drug. The fact that haloperidol administration was associated with older age, acute procedures, and major procedures, which are all established risk factors for delirium, suggests that delirium could be the most important indication for its prescription [ 18 ].
However, we do not know the indication of haloperidol use, and the known risk factors for delirium—such as operative stress and other drugs used peri- and postoperatively—are not measured in our database. It is possible that approximately 0. Additionally, the multivariate analysis showed that haloperidol use was associated with longer hospital stay, which might be another indirect clue that patients who received haloperidol experienced delirium because delirium is known to be associated with a prolonged hospital stay [ 19 ].
Alternatively, the use of haloperidol itself may have contributed to the length of stay. More broadly, this study shows that large numbers of older people received haloperidol during their hospitalisation for surgery. This level of haloperidol use is notable given the lack of strong evidence for the benefits of this drug in the treatment of delirium. No previous study has investigated the appropriate antipsychotic dosage levels for delirium, and we believe different countries have different antipsychotic dosage strategies [ 9 ].
This risk is present even during the first week of antipsychotic use [ 21 ]. In light of this, haloperidol should be prescribed carefully, especially in the absence of scientific medical evidence. Additionally, electronic records are a reliable way to capture medication use in a hospital setting. Some limitations should be acknowledged. The study was retrospective; we did not prospectively collect data on indications for haloperidol use.
Retrospective analysis of medical charts could yield more relevant information. For example, indications for prescription, such as behavioral disorder or psychotic disorder, could not be taken into account because this detailed information was missing.
Furthermore, the study of adverse events in relation to haloperidol use was beyond the scope of this study. Moreover, we limited this study to haloperidol users and did not investigate other atypical antipsychotics. However, in the Netherlands, haloperidol is the first medication of choice for the treatment of delirium in elderly patients in hospital [ 17 ]. This study indicates that substantial numbers of older patients undergoing procedures are prescribed haloperidol, with an overall frequency of 5.
The highest use is in older patients undergoing major or acute procedures. This study is the first study to evaluate the use of haloperidol in a large hospital population with various surgical procedures. Given the large-scale use of haloperidol, further research on the benefits, side effects, and costs of this treatment is urgently required.
None of the authors Prof. Lefeber, H Nijboer has any conflicts of interest that are directly relevant to the content of this study. No sources of funding were used to assist in the preparation of this study.
National Center for Biotechnology Information , U. Drugs Real World Outcomes. Published online Mar 3. This article has been corrected. See Drugs Real World Outcomes. Abstract Background Haloperidol, frequently used for delirium, can lead to serious side effects, of which QTc prolongation is the most worrisome since it is associated with an increased risk of fatal cardiac arrhythmia.
Results A total of procedures took place in elderly patients, and patients were readmitted for a second procedure in the same year. Conclusion We show a frequency of haloperidol use of 5. The percentage of haloperidol users is higher in older patients undergoing acute or major procedures. Patients using haloperidol experienced a longer hospital stay in this study and are known to have a higher risk of adverse events in the literature.
Open in a separate window. Introduction In , the US FDA warned clinicians against prescribing antipsychotic medications to patients with dementia-related psychosis, because it would expose patients to an increased risk of death [ 1 ]. Study Design Haloperidol administration during admission was identified using the electronic hospital drug database.
Results A total of procedures occurred in patients; patients underwent a second procedure during their first admission, and patients were admitted for at least one additional procedure in the same year. CI confidence interval, OR odds ratio a All surgeries except general or orthopedic surgery.
Conclusion This study indicates that substantial numbers of older patients undergoing procedures are prescribed haloperidol, with an overall frequency of 5.
Compliance with ethical standards Conflict of interest None of the authors Prof. Funding No sources of funding were used to assist in the preparation of this study. Ethical approval Ethical approval was not required for this study.
Administration F and D. Antipsychotics conventional and atypical. Risk of cerebrovascular adverse events and death in elderly patients with dementia when treated with antipsychotic medications: Choice of observational study design impacts on measurement of antipsychotic risks in the elderly: Comparative safety of antipsychotics in the WHO pharmacovigilance database: Int J Clin Pharm.
Usefulness of atypical antipsychotics and choline esterase inhibitors in delirium: Systemic inflammation induces acute working memory deficits in the primed brain: A standard procedure for creating a frailty index.
Consensus and variations in opinions on delirium care: Pharmacological and nonpharmacological management of delirium in critically ill patients.
Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium. Quetiapine versus haloperidol in the treatment of delirium: Drug Des Devel Ther. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Ondasetron versus haloperidol for the treatment of postcardiotomy delirium: Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium.