When should I administer Hadiol to a patient?

When to Administer Haloperidol (Hadiol)

Haloperidol should be administered for acute management of agitation, delirium, or psychosis, with a recommended starting dose of 0.5-1 mg orally or subcutaneously for most adult patients, particularly when rapid symptom control is needed. 1

Indications for Haloperidol Administration

• First-line treatment for delirium with agitation or psychotic symptoms in adult patients, particularly when rapid control of symptoms is needed 1
• Management of severe agitation in emergency department settings, with 83% of patients showing decreased disruptive behavior within 30 minutes of administration 1
• Treatment of psychotic symptoms in patients with cancer-related delirium, where haloperidol remains the first-generation antipsychotic of choice 1

Dosing Guidelines

Initial Dosing

• Standard starting dose: 0.5-1 mg orally (p.o.) or subcutaneously (s.c.) 1
• For PRN (as needed) dosing: 0.5 or 1 mg p.o. or s.c. every 1 hour as needed 1
• For scheduled dosing: Give every 8-12 hours if regular administration is required 1
• Lower doses (0.25-0.5 mg) should be used in older or frail patients with gradual titration 1

Route of Administration

• Oral and subcutaneous routes are most common for non-emergency situations 1
• Intravenous administration requires ECG monitoring 1
• Intramuscular administration is also an option for more urgent situations 1

Precautions and Contraindications

Important: Haloperidol should be used with extreme caution or avoided in the following conditions:

• Parkinson's disease or dementia with Lewy bodies due to high risk of extrapyramidal side effects (EPSEs) 1
• Patients with prolonged QTc interval (risk of further QTc prolongation) 1
• Patients with history of seizures (may lower seizure threshold) 1
• Severe hepatic or renal impairment (altered drug metabolism) 1

Monitoring Requirements

• Monitor for extrapyramidal side effects (muscle stiffness, tremor, dystonic reactions) 1
• ECG monitoring is recommended when administering intravenously due to risk of QTc prolongation 1
• Assess response to treatment regularly to determine need for continued therapy 1
• Monitor vital signs, particularly in elderly patients or those with cardiovascular disease 1

Common Side Effects to Watch For

• Extrapyramidal symptoms (EPSEs) including acute dystonic reactions 1
• QTc interval prolongation 1
• Sedation (though less sedating than some other antipsychotics) 1
• Orthostatic hypotension 1
• Anticholinergic effects (dry mouth, urinary retention, constipation) 1

Special Populations

Elderly Patients

• Use lower starting doses (0.25-0.5 mg) 1
• Titrate dose more gradually 1
• Monitor more closely for side effects, particularly EPSEs and sedation 1

Patients with Hepatic/Renal Impairment

• Dose reduction may be necessary 1
• More frequent monitoring for adverse effects 1

Alternative Medications to Consider

If haloperidol is contraindicated or poorly tolerated, consider:

• Second-generation antipsychotics like olanzapine (2.5-5 mg) or quetiapine (25 mg) for delirium management 1
• Benzodiazepines (e.g., lorazepam 1 mg) for alcohol or benzodiazepine withdrawal delirium 1
• Combination therapy with lorazepam may be more effective than lorazepam alone for acute agitation 1

Clinical Pearls

• Haloperidol has less sedative effect compared to other antipsychotics like chlorpromazine or olanzapine 1
• For severe agitation requiring rapid control, combination of haloperidol with lorazepam may be more effective than either agent alone 1
• Short-term use at the lowest effective dose is recommended to minimize adverse effects 1
• Always document baseline mental status before administration to help assess response 1