|
|
|
HALOPERIDAL
HALOPERIDOL
Guidelines for Use
in the treatment of Behavioral Disturbance due to Delirium
Delirium is:
a. Disturbance of consciousness with inability to focus, sustain, or shift attention
b. Change in cognition (memory, disorientation, language disturbance) or development of perceptual disturbance not better accounted for by dementia
c. Develops over short period of time and tends to fluctuate over course of day
d. Evidence that it is caused by the direct physiologic cause of a medical disturbance
Treatment of Delirium:
1. Recognition and diagnosis
2. Differential consideration of likely etiologies
• Central nervous system disorders (seizures, brain injury, stroke, bleed, malignancy…)
• Metabolic/Endocrine (hyper/hypoglycemia, thiaminedeficiency, hypothyroidism, electrolyte abnomalities, endocrine, uremia, acid-base, anemia, hepatic…)
• Cardiovascular (arrythmia, MI, CHF, hypertension, shock…)
• Systemic illness (organ failure, hypoxia, infection/sepsis, neoplasm, severe trauma, postoperative…)
• Drugs of abuse (withdrawal or intoxication)
• Medications (anticholinergic side effects, lasix, elavil, demeral, benzodiazepines, digoxin…)
• Toxins (anticholinesterase, organophosphates, co poisoning…)
1. Discontinue offending drugs
2. Reverse/treat medical causes
3. Begin neuroloeptic medication to manage the symptoms of delirium (while correcting the underlying medical etiology). Haloperidal is the most studied and accepted due to its low incidence of anticholinergic and orthostatic side effects. It can cause extrapyramidal side effects (rigidity, dystonia, and akthesia), cardiovascular complications (torsades de pointes) and neuroleptic malignant syndrome. Long term complications from antipsychotics include tardive dyskinesia.
Oral Dosing:
1 – 15 mg daily depending on severity of symptoms – 1-2 mg PO every hour as needed for first 24 hours. Divide total dose to TID-QID dosing. Taper by 25% daily after stable.
Intramuscular Dosing:
Follow oral dosing guidelines initially, until patient can take PO or IV access can be established (increased risk for neuroleptic malignant syndrome when administered IM)
Intravenous Dosing:
For
adults 18-64 years of age: haloperidol 1-5 mg IV q6h prn agitation/delirium.
Maximum dose is 20 mg/day. If patient requires >20 mg/day, physician assessment
and documentation is required.
For
adults 65 years of age and older: haloperidol 0.5-2 mg IV q6h prn
agitation/delirium. MAXIMUM OF 2MG IN 4 HRS AND 4MG IN 24 HR PERIOD. PRN dosing
should be permitted only for 24 hours. To reorder after a 24 hour period,
physician assessment and documentation is required.
It is preferable to administer the IV dose by piggyback or in a large volume fluid rather than push. Note: I.V. haldol will precipitate with heparin, flush line with saline.
Monitor:
Blood pressure
* Obtain
baseline ECG prior to giving haloperidol IV. Monitor ECG before each dose.
Record QTc. If QTc is greater than 0.46 seconds, hold haloperidol and notify
physician.
Monitor for signs
of neuroleptic malignant syndrome (new fever greater than 100 degree F,
tachycardia, labile blood pressure with hypo-/hypertension, confusion and muscle
rigidity). Hold haloperidol and notify physician.
Monitor for
extrapyramidal reactions, including dystonic reactions (neck rigidity, swollen
tongue, and oculogyric crisis). Hold haloperidol and notify physician.
Magnesium and Phosphorus
Haloperidol is an a-adrenergic antagonist and arterial hypotension must be treated with phenylephrine or norepinephrine
Last Revision: 01/2008
|
 |
