From the Guidelines
I would not recommend giving Haldol (haloperidol) to this patient with a CIWA score of 21 who has already received Ativan and Zofran. A CIWA score of 21 indicates moderate to severe alcohol withdrawal, and benzodiazepines like Ativan (lorazepam) are the first-line treatment for both the withdrawal symptoms and associated nausea. Adding Haldol could lower the seizure threshold and potentially worsen withdrawal symptoms. Instead, consider increasing the Ativan dosage or frequency based on the CIWA protocol your facility uses. The patient has already received Zofran (ondansetron) for nausea, which is appropriate, as suggested by 1 that nausea and vomiting should be managed with medications that target dopaminergic pathways, but in this context, benzodiazepines are preferred for alcohol withdrawal. If nausea persists, other antiemetics like Phenergan (promethazine) or Reglan (metoclopramide) would be safer alternatives than Haldol in this context, as they can target different pathways without increasing the risk of seizures or worsening withdrawal symptoms, consistent with recommendations for managing nausea and vomiting in various clinical contexts 1. The priority should be adequately treating the underlying alcohol withdrawal with benzodiazepines, which will often improve associated symptoms including nausea. Continuous monitoring of the patient's CIWA score is essential to guide further treatment decisions. Given the patient's condition and the potential risks associated with Haldol, transferring the patient back to the ICU for closer monitoring and management may be necessary, especially if there are concerns about the patient's ability to safely manage their withdrawal symptoms and nausea in the current setting.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Assessment
- The patient has a CIWA score of 21, indicating moderate to severe withdrawal symptoms.
- The patient has already received Ativan (lorazepam) and Zofran (ondansetron) for nausea and vomiting.
- The last dose of Ativan was given at 0013.
Use of Haldol for Nausea
- There is limited evidence to support the use of Haldol (haloperidol) for nausea and vomiting in patients with a CIWA score of 21 2.
- One study found that Haldol was noninferior to ondansetron for the treatment of established postoperative nausea and vomiting, but it was associated with sedation 3.
- Another study compared the antiemetic effect of high-dose intravenous metoclopramide and high-dose intravenous haloperidol, and found that metoclopramide was slightly more effective, but both drugs were excellent antiemetics when given in sufficient dosage by an effective route 4.
Considerations for Treatment
- The patient has already received Ativan and Zofran, and the use of Haldol may increase the risk of sedation and other adverse effects.
- The patient's CIWA score and symptoms should be closely monitored, and alternative treatments for nausea and vomiting should be considered if necessary.
- The use of Haldol for nausea and vomiting in this patient population is not well established, and more research is needed to determine its efficacy and safety 2, 3, 5, 4, 6.