Can a patient take Haloperidol (antipsychotic medication) preoperatively?

Preoperative Use of Haloperidol

Haloperidol should not be routinely used preoperatively due to its potential to cause delirium and adverse effects without clear benefit. 1

Recommendations for Haloperidol Use Preoperatively

General Considerations

• Haloperidol is not recommended for routine preoperative use as a preventive measure for delirium 1
• The Society of Critical Care Medicine specifically suggests against using haloperidol to treat delirium in critically ill adults (conditional recommendation, low quality of evidence) 1
• Haloperidol may increase the risk of QT prolongation when combined with other medications used in the perioperative setting 1

Drug Interactions

• Haloperidol has potential interactions with several drugs commonly used in the perioperative period:
  • When combined with hydroxychloroquine, there is increased risk of cardiac toxicity 1
  • When combined with lopinavir/ritonavir, haloperidol exposure may be increased, requiring dose adjustment or monitoring 1
  • Haloperidol can have additive effects with other medications that prolong QT interval 1

Patient-Specific Considerations

• Elderly patients (≥65 years) should avoid haloperidol preoperatively due to:
  • Increased risk of cognitive impairment 2
  • Higher risk of delirium 1
  • Increased risk of falls 2
  • Potential for impaired motor function 2

Alternative Approaches for Preoperative Management

Non-Pharmacological Alternatives

• Comprehensive preoperative education is recommended as first-line for anxiety management 2
• Non-pharmacological anxiety management techniques should be prioritized over medication when possible 2

Pharmacological Alternatives

• If medication for anxiety is necessary, consider:
  • Melatonin, which provides effective preoperative anxiolysis with minimal side effects 2
  • Passionflower supplements, which have demonstrated reduction in anxiety with good safety profiles 2
• If sedation is required, short-acting benzodiazepines at the lowest effective dose may be used in non-elderly patients 2

Special Circumstances

Postoperative Nausea and Vomiting (PONV) Prevention

• Low-dose haloperidol (0.5-2mg) has shown efficacy in preventing PONV 3
• Gender differences exist in response to low-dose haloperidol for PONV prevention:
  • More effective in male patients (adjusted odds ratio = 0.45) 4
  • Less effective in female patients (adjusted odds ratio = 1.02) 4
• Combination of haloperidol 2mg plus dexamethasone 5mg has shown superior PONV prevention compared to either drug alone 3

Patients on Chronic Haloperidol

• For patients already on chronic haloperidol therapy, continuation until the time of surgery is generally recommended 5
• Abrupt discontinuation could lead to withdrawal symptoms or exacerbation of underlying psychiatric conditions 5, 6

Conclusion for Clinical Practice

• Avoid routine preoperative haloperidol use for most patients 1
• Consider the specific indication carefully if haloperidol is being considered 1
• Use non-pharmacological approaches for preoperative anxiety management whenever possible 2
• If haloperidol must be used, employ the lowest effective dose and monitor for QT prolongation and other adverse effects 1, 2