From the Research
For elderly patients, the recommended IV haloperidol (Haldol) dosing over 24 hours should generally not exceed 2 mg total, administered in divided doses of 0.5 mg every 4-8 hours as needed, as supported by the most recent study 1. This approach prioritizes minimizing the risk of adverse effects, particularly QT prolongation, extrapyramidal symptoms, and sedation, which are more common in elderly patients due to their increased sensitivity to antipsychotics. Key considerations include:
- Starting with the lowest effective dose, typically 0.5 mg, and titrating cautiously based on response and side effects.
- Close cardiac monitoring, especially if the patient has cardiac risk factors or is on other QT-prolonging medications.
- Using haloperidol for the shortest duration possible to manage acute agitation or delirium, with reassessment every 24 hours.
- Considering consultation with a geriatrician or psychiatrist for patients requiring ongoing treatment.
- Implementing non-pharmacological approaches concurrently and identifying and addressing underlying causes of agitation whenever possible, as suggested by various studies 2, 3, 4.