From the Guidelines
Haldol (haloperidol) can be given to an agitated elderly woman in her 80s, but it should be used with caution due to increased risk of adverse effects in older adults. For acute agitation, a low starting dose of 0.5-1 mg orally is recommended, with careful monitoring for side effects, as suggested by the most recent guideline 1. Alternatives to consider first include non-pharmacological approaches like reorientation, addressing underlying causes (pain, infection, dehydration), and creating a calm environment. If medication is necessary, consider starting with less risky options like lorazepam 0.25-0.5 mg, as benzodiazepines have been shown to be effective in reducing agitation and are at least as effective as haloperidol in control of the agitated patient 1. Some key points to consider when using Haldol include:
- Starting with a low dose and titrating as needed
- Monitoring for extrapyramidal symptoms, QT prolongation, and increased mortality in elderly patients with dementia
- Checking for contraindications including Parkinson's disease, Lewy body dementia, prolonged QT interval, or history of neuroleptic malignant syndrome
- Documenting the reason for use, monitoring vital signs and mental status, and transitioning to non-pharmacological management as soon as possible. It's also important to note that verbal restraint strategies, such as respecting personal space, minimizing provocative behavior, and establishing verbal contact, can be effective in de-escalating agitation 1. Overall, the goal is to prioritize the patient's safety and well-being while minimizing the risk of adverse effects.
From the FDA Drug Label
WARNINGS Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. The pharmacokinetics of haloperidol in geriatric patients generally warrants the use of lower doses
Caution is advised when considering haloperidol for an agitated elderly woman in her 80s, due to the increased risk of mortality, tardive dyskinesia, and other adverse effects in this population.
- The FDA drug label recommends using the smallest dose and shortest duration of treatment to minimize the risk of adverse effects.
- Alternative treatments should be considered before initiating haloperidol therapy in elderly patients.
- The decision to use haloperidol in this patient should be made with caution and careful consideration of the potential risks and benefits, as stated in the drug label 2 and 2.
From the Research
Medication Options for Agitated Elderly Women
- Haldol (haloperidol) is a typical antipsychotic that can be used to manage agitation in elderly patients, but it is associated with extrapyramidal symptoms 3.
- The combination of haloperidol and promethazine may be a good choice for managing agitation, as it combines the sedative properties of the antihistamine with the calming action of haloperidol, with a reduced risk of extrapyramidal effects 3.
- Benzodiazepines, such as lorazepam, can also be used to manage agitation in elderly patients, and have been shown to be effective in reducing agitation in clinical trials 4.
- Other medication options, such as atypical antipsychotics (e.g. olanzapine, aripiprazole, ziprasidone) and α2 agonists, may also be considered for managing agitation in elderly patients 3, 5.
Important Considerations
- It is essential to understand the etiology of agitation in an older adult to provide proper management 6.
- Non-pharmacologic modalities, such as massage therapy, animal-assisted intervention, and personally tailored intervention, can be effective in reducing agitation in people with dementia 7.
- Geriatric-specific dosing, contraindications, and common adverse effects of medications should be considered when managing agitation in elderly patients 6.