From the FDA Drug Label
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. The best treatment for a client experiencing delirium tremens (DTs) from alcohol withdrawal is not explicitly stated in the provided drug label. The initial dose of Haldol (haloperidol) to administer for this condition is also not directly stated in the label. The label provides dosing recommendations for schizophrenic patients who require prolonged parenteral antipsychotic therapy, but it does not address the treatment of delirium tremens (DTs) from alcohol withdrawal. Key points:
- The label does not provide information on the treatment of delirium tremens (DTs) from alcohol withdrawal.
- The initial dose of Haldol (haloperidol) for this condition is not specified in the label. 1
From the Research
For a client experiencing delirium tremens (DTs) from alcohol withdrawal, the recommended initial treatment is benzodiazepines, specifically diazepam, with a dose of 260-480 mg/day IV, as it has been shown to effectively control symptoms in severe cases 2. The treatment of delirium tremens (DTs) from alcohol withdrawal requires a comprehensive approach that prioritizes the patient's safety and comfort.
Key Considerations
- Benzodiazepines are the mainstay of treatment for DTs, and diazepam is a preferred option due to its faster onset of action and effectiveness in controlling symptoms 2, 3.
- The dose of diazepam may need to be adjusted based on the patient's response, and high doses may be required in some cases 2.
- Haldol (haloperidol) is not recommended as first-line therapy for alcohol withdrawal due to its potential to lower the seizure threshold, but it may be used as an adjunct for severe agitation or hallucinations not controlled by benzodiazepines 4.
- The treatment should also include thiamine 100 mg IV/IM daily, fluid replacement, electrolyte correction (particularly magnesium and potassium), and continuous vital sign monitoring.
Treatment Approach
- A symptom-triggered approach using a validated assessment tool like the CIWA-Ar scale is recommended to guide medication dosing 5, 4.
- The patient's response to treatment should be closely monitored, and adjustments made as needed to ensure their safety and comfort.
- The treatment of DTs should be followed by treatment for alcohol dependence to prevent future episodes.
Medication Dosing
- Diazepam: 260-480 mg/day IV, adjusted based on patient response 2.
- Lorazepam: 2-4 mg IV every 1-4 hours as needed, or 5-10 mg IV every 5-10 minutes until sedation is achieved, then every 1-4 hours as needed.
- Haldol (haloperidol): 2-5 mg IV/IM, repeated every 30-60 minutes as needed, with close monitoring.