Optimal Injectable Haloperidol Dose Assessment in the Older Hospitalized Inpatient

Area of Science:

• Geriatric Medicine
• Psychopharmacology
• Clinical Pharmacology

Background:

• Haloperidol is frequently used off-label for agitation and delirium in elderly individuals.
• Current recommended initial doses (0.5-1 mg IM/IV) lack robust supporting evidence.
• Investigating lower doses is crucial for optimizing geriatric care.

Purpose of the Study:

• To compare the efficacy of low-dose injectable haloperidol (≤0.5 mg) versus higher doses.
• To evaluate secondary outcomes including length of stay, restraint use, and discharge disposition.
• To establish optimal dosing strategies for agitated older adults.

Main Methods:

• Retrospective, single-center cohort study.
• Inclusion criteria: patients aged ≥65 years receiving injectable haloperidol without prior antipsychotic use.
• Primary outcome: need for repeat haloperidol doses within 4 hours.

Main Results:

• No significant difference in repeat dosing was observed between low-dose (≤0.5 mg) and higher-dose haloperidol groups (P=0.94).
• Low-dose haloperidol was associated with a shorter length of stay and reduced need for restraints.
• Discharge outcomes favored the low-dose group when patients were admitted from home.

Conclusions:

• Low-dose injectable haloperidol (≤0.5 mg) demonstrates comparable efficacy to higher doses in managing agitation in older adults.
• Secondary outcomes suggest potential benefits of lower doses, including reduced hospital stay and restraint utilization.
• Low-dose haloperidol represents a viable and potentially advantageous initial treatment option for agitated elderly patients.