title: Haloperidol overdosing in the treatment of agitated hospitalized older people with delirium: a retrospective chart review from a community teaching hospital.
abstract: BACKGROUND
  Practice guidelines recommend the use of low dose haloperidol when medication is needed to treat delirium with acute agitation in hospitalized older people. Despite this, high dose haloperidol may frequently be used and result in higher rates of complications.
  
  
  OBJECTIVE
  To describe dosages and effects of haloperidol used in the initial treatment of delirium with acute agitation in hospitalized older people, and prescriber use of low and high dose haloperidol.
  
  
  METHODS
  Retrospective chart reviews were performed from June 2008 to May 2009 in a community teaching hospital located in Upland, PA, USA. Patients aged 65 years and older with acute agitated delirium were included. Patients admitted to ICU and those with psychiatric conditions were excluded. Data were collected on haloperidol dosing, responses, sedation, length of stay, and concurrent use of lorazepam.
  
  
  RESULTS
  A total of 261 charts of patients who received haloperidol were reviewed and 56 patients met inclusion criteria (14 males, 42 females). The mean age of subjects was 83 years. The recommended starting dose of haloperidol (0.5 mg) was administered to 35.7 % of the patients. An initial dose of more than 1 mg was received by 37.5 % of the patients. The remaining 26.8 % of patients received 1 mg. The relative risk of sedation was significantly greater for subjects receiving more than 1 mg of haloperidol in 24 h. The length of hospitalization was not predicted by haloperidol doses or lorazepam but by the number of days of agitation.
  
  
  CONCLUSIONS
  Higher than recommended initial doses of haloperidol were frequently used in the treatment of delirium with acute agitation in hospitalized older people. We found no evidence to suggest that higher dosages were more effective in decreasing the duration of agitation or the length of hospital stay. Low dose haloperidol appears to be as effective as and safer than higher doses in the treatment of acute agitation in this older population.
authors: Division of Geriatrics, Crozer-Chester Medical Center, Upland, PA 19013, USA. william.zirker@crozer.org
authors: William
authors: W
authors: Zirker
authors: Igor
authors: I
authors: Dorokhine
authors: Clifford M
authors: CM
authors: Knapp
authors: Nayan
authors: N
authors: Patel
authors: Mary
authors: M
authors: Musuku
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy* / Q000503:physiopathology; D018492:Dopamine Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006220:Haloperidol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008140:Lorazepam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'; D011595:Psychomotor Agitation / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D014151:Anti-Anxiety Agents; D018492:Dopamine Antagonists; D018757:GABA Modulators; D006220:Haloperidol; D008140:Lorazepam
references: Ann Intern Med. 1990 Dec 15;113(12):941-8
references: 2240918
references: J Am Geriatr Soc. 2003 Feb;51(2):234-9
references: 12558721
references: BMJ. 2007 Apr 21;334(7598):842-6
references: 17446616
references: BMJ. 2010 Jul 28;341:c3704
references: 20667955
references: Arch Gen Psychiatry. 1981 Feb;38(2):195-9
references: 7011249
references: J Neurol Neurosurg Psychiatry. 2010 Aug;81(8):876-81
references: 20587481
references: Drugs Aging. 1998 Aug;13(2):119-30
references: 9739501
references: Am J Med Genet B Neuropsychiatr Genet. 2010 Jan 5;153B(1):38-45
references: 19309018
references: Clin Pharmacokinet. 1999 Dec;37(6):435-56
references: 10628896
references: J Am Geriatr Soc. 2000 Dec;48(12):1697-706
references: 11129764
references: Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005594
references: 17443602
references: Am J Psychiatry. 1999 May;156(5 Suppl):1-20
references: 10327941
references: CNS Drugs. 2001;15(9):671-8
references: 11580306
references: J Am Geriatr Soc. 2005 Feb;53(2):312-8
references: 15673358
references: J Am Geriatr Soc. 2011 Nov;59 Suppl 2:S269-76
references: 22091572
references: Am J Psychiatry. 1996 Jul;153(7):948-50
references: 8659621