Can Haloperidol (Haldol) be administered via intravenous (IV) push?

From the Guidelines

Yes, Haldol (haloperidol) can be administered as an IV push, but this should be done with caution and under specific conditions, as stated in the most recent guideline evidence from 2018 1. The recommended administration of haloperidol is 0.5–1 mg p.o. or s.c. stat, and it can also be given i.v. with ECG monitoring. When administering Haldol IV, patients should be on continuous cardiac monitoring due to the risk of QT prolongation and potential for torsades de pointes, as warned by the 2013 guideline evidence 1. Common indications for IV Haldol include acute agitation, delirium, and psychosis in hospitalized patients. Side effects to monitor include extrapyramidal symptoms, sedation, hypotension, and cardiac arrhythmias. IV Haldol should be avoided in patients with known QT prolongation, recent myocardial infarction, uncompensated heart failure, or those taking other medications that prolong the QT interval, as suggested by the 2016 study 1. The mechanism of action involves dopamine receptor blockade in the brain, which helps control agitation and psychotic symptoms. For many patients, oral or intramuscular administration may be safer alternatives when appropriate, as recommended by the 2020 guideline evidence 1. Some key points to consider when administering haloperidol include:

• Starting dose: 0.5-1 mg orally or subcutaneously
• Maximum daily dose: 10 mg, or 5 mg in elderly patients
• Administration route: oral, subcutaneous, or intravenous with ECG monitoring
• Monitoring: continuous cardiac monitoring, extrapyramidal symptoms, sedation, hypotension, and cardiac arrhythmias.

From the FDA Drug Label

HALOPERIDOL INJECTION IS NOT APPROVED FOR INTRAVENOUS ADMINISTRATION. If haloperidol injection is administered intravenously, the ECG should be monitored for QTc prolongation and arrhythmias.

Haloperidol (Haldol) administration via intravenous (IV) push is not approved. Although it may be administered intravenously in certain situations, it is not the recommended route of administration and requires careful monitoring of the patient's ECG for QTc prolongation and arrhythmias 2 2.

From the Research

Administration of Haloperidol

• Haloperidol can be administered via intravenous (IV) push, but it is essential to consider the potential risks and benefits associated with this route of administration 3, 4.
• The use of IV haloperidol has been reported to be effective in controlling severe agitation and delirium in critically ill patients, but it requires close monitoring for QT prolongation or rhythm disturbances 3, 4.
• Studies have shown that IV haloperidol can cause QTc prolongation, which can increase the risk of torsade de pointes, a potentially life-threatening arrhythmia 4, 5.
• The risk of QTc prolongation is higher when haloperidol is combined with other medications, such as lorazepam or prothipendyl 5.

Safety Precautions

• Close monitoring of the patient's ECG is recommended when administering IV haloperidol to detect any potential QT prolongation or rhythm disturbances 3, 4.
• The use of IV haloperidol should be avoided in patients with a history of QT prolongation or other cardiac arrhythmias 4.
• Alternative routes of administration, such as intramuscular or oral, may be considered in patients who are at high risk of QT prolongation or other cardiac complications 6, 7.

Clinical Considerations

• The decision to administer IV haloperidol should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 3, 4.
• Clinicians should be aware of the potential risks and benefits associated with IV haloperidol and take steps to minimize the risk of adverse effects 4, 5.