Torsade de pointes associated with the administration of intravenous haloperidol:a review of the literature and practical guidelines for use.
Haloperidol is the most commonly used medication for the treatment of delirium and psychosis in the critically ill patient. Whilst generally considered to be safe, haloperidol has been associated with a number of important cardiovascular side effects. The major toxicities include hypotension, cardiac arrhythmias and prolongation of the corrected QT (QTc) interval. In particular, torsade de pointes, a polymorphic ventricular tachyarrhythmia, has been associated with both intravenous and oral haloperidol administration. The management of torsade de pointes consists of discontinuation of the possible offending agent(s), correction of electrolyte abnormalities, administration of magnesium sulfate and, if necessary, overdrive pacing. Although clinicians should be aware of this potentially lethal complication of intravenous haloperidol therapy, it should not deter clinicians from using intravenous haloperidol to treat acute agitation in the critically ill patient with a normal QTc.
Hassaballa
Hesham A
HA
Division of Pulmonary and Critical Care Medicine, Rush-Presbyterian St Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
Balk
Robert A
RA
D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D008278:Magnesium Sulfate / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000628:therapy*
D014150:Antipsychotic Agents; D008278:Magnesium Sulfate; D006220:Haloperidol