What is the recommended dosing of Haldol (haloperidol) intramuscularly (IM) for acute agitation?

From the Guidelines

For acute agitation, the recommended intramuscular (IM) dosing of Haldol (haloperidol) is typically 0.5-1 mg, which can be repeated every 1 hour as needed until agitation is controlled, as suggested by the most recent guidelines 1. When administering Haldol IM, it's crucial to use the lowest effective dose to minimize the risk of extrapyramidal side effects (EPSEs) and other adverse reactions.

• The dose may need to be adjusted based on the patient's response and tolerance, with a maximum daily dose generally not exceeding 5 mg in frail or elderly patients.
• For most adults, the dose can be repeated every 1 hour as needed, but it's essential to monitor the patient closely for signs of oversedation or adverse effects.
• The use of Haldol IM should be cautious in patients with cardiac conditions or those taking other QT-prolonging medications, as haloperidol can prolong the QT interval 1.
• It's also important to consider alternative treatment options, such as benzodiazepines or other antipsychotics, depending on the patient's specific needs and medical history, as outlined in the guidelines 1. Key considerations when using Haldol IM include:
• Monitoring for sedation, vital sign changes, and EPSEs (muscle stiffness, tremor, restlessness)
• Having diphenhydramine (25-50 mg) or benztropine (1-2 mg) available to treat acute dystonic reactions if they occur
• Transitioning to oral medication when possible for continued management
• Being aware of the potential for haloperidol to prolong the QT interval and using caution in patients with cardiac conditions or those taking other QT-prolonging medications.

From the Research

Haldol PRN Agitation Dosing IM

• The recommended dosing of Haldol (haloperidol) intramuscularly (IM) for acute agitation is not explicitly stated in the provided studies, but it is mentioned that haloperidol 7.5 mg IM is a common dose used for acute agitation 2, 3, 4.
• A study comparing IM olanzapine and haloperidol found that haloperidol 7.5 mg IM effectively reduced agitation over 24 hours, but had a higher incidence of extrapyramidal symptoms compared to olanzapine 3.
• Another study found that IM haloperidol 5 mg and 10 mg had a lower proportion of patients adequately sedated at 15 minutes compared to midazolam and olanzapine 5.
• The studies suggest that the dose of haloperidol used for acute agitation can vary, but 5-10 mg IM is a common range 2, 3, 4, 5.

Comparison with Other Medications

• IM olanzapine has been shown to be effective in reducing agitation and has a more favorable safety profile compared to haloperidol 3, 4.
• IM ziprasidone has also been shown to be effective in reducing agitation, but its efficacy compared to haloperidol is not as well established 6.
• Midazolam has been found to be more effective than haloperidol, ziprasidone, and olanzapine in achieving sedation at 15 minutes 5.

Safety Considerations

• Haloperidol can cause significant extrapyramidal symptoms, and has rarely been associated with cardiac arrhythmia and sudden death 2.
• The use of haloperidol and other antipsychotics should be carefully considered, especially in patients with known medical conditions or taking other medications that may interact with these drugs 2, 3, 4, 5.