Home Delirium/Dementia More data in the case against haloperidol for delirium in the ICU

More data in the case against haloperidol for delirium in the ICU

Haloperidol for delirious ICU patients is a go-to strategy for many doctors, but new data are raising questions about its effectiveness.

November 2022

A NEW STUDY in the New England Journal of Medicine found that using haloperidol to treat delirium in ICU patients doesn’t improve patient mortality. Researchers found no difference in 90-day mortality between ICU patients receiving haloperidol vs. placebo.

Guidelines don’t back the use of haloperidol in the ICU for delirium, but as the authors note, the drug continues to be a go-to in the ICU for that indication.

In the study, 1,000 ICU patients with delirium were randomized to receive either IV haloperidol or placebo for as long as patients were delirious and as-needed for recurrences. Haloperidol was given in a 2.5 mg dose three times a day. Up to 2.5 mg of the drug could also be given on an as-needed basis for a maximum daily dose of 20 mg.

The study’s primary endpoint was the number of days patients were alive and out of the hospital at 90 days.

The results: At 90 days, the mean number of days alive and out of the hospital was 35.8 for those given haloperidol vs. 32.9 in the placebo group. Mortality was 36.3% in the haloperidol cohort vs. 43.3% in the placebo group.

The number of serious adverse reactions was virtually the same in both groups (11 vs. 9).

Researchers pointed to data from a 2018 New England Journal study, which found haloperidol didn’t seem to be very effective in treating delirious ICU patients. That study compared haloperidol, ziprasidone and placebo in ICU patients with delirium. Researchers found that neither of the two agents affected delirium duration.

A MedPage Today report on the new study says that nonpharmacological interventions including getting patients out of bed and enlisting the help of family members—are the best course, once doctors stop drugs like sedatives that might be making patients delirious.

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