Anyone else out there that loves haldol as much as myself?

[GeneralVeers]

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We have it. Until I use it all.

I am using it daily now. The nurses are amazed at how it turns screaming zombies into otherwise pleasant, normal people who want to go home.

 

[TooMuchResearch]

"My doctor treats my headaches with morphine."

In my head I think, "your doctor is too old to do this anymore." But in the EMR I order droperidol and the patient generally feels better within 45 minutes.

I am using it daily now. The nurses are amazed at how it turns screaming zombies into otherwise pleasant, normal people who want to go home.

 

[KGflyboy]

Question for those using haldol for headaches. It seems many people use it for this purpose. Are you guys using it in place of the typical migraine cocktail which seems to be compazine or Regan, toradol, and Benadryl, or are you using it as 2nd line for resistant headaches?

I hesitate to give haldol after first giving Compazine or Regan given they all block dopamine receptors.

On the same subject, since all 3 meds block dopamine receptors, what gives haldol the "STFU" effect that doesn't seem to occur with the other meds? Perhaps it is due to action on different subtypes of dopamine receptors. Perhaps haldol is just more potent but acts on the same receptors. Or perhaps there is a different I'm not thinking of.

 

[DrGasPasser]

Question for those using haldol for headaches. It seems many people use it for this purpose. Are you guys using it in place of the typical migraine cocktail which seems to be compazine or Regan, toradol, and Benadryl, or are you using it as 2nd line for resistant headaches?

I hesitate to give haldol after first giving Compazine or Regan given they all block dopamine receptors.

On the same subject, since all 3 meds block dopamine receptors, what gives haldol the "STFU" effect that doesn't seem to occur with the other meds? Perhaps it is due to action on different subtypes of dopamine receptors. Perhaps haldol is just more potent but acts on the same receptors. Or perhaps there is a different I'm not thinking of.

I typically use it after compazine. Occasionally it’s first line in patients who have done really well with it.

 

[KGflyboy]

I typically use it after compazine. Occasionally it’s first line in patients who have done really well with it.

So it doesn't seem odd to give 2 typical antipsychotics back to back? Seems like it would increase the risk of extra-pyramidal and cardiac conduction adverse effects.

 

[thegenius]

So it doesn't seem odd to give 2 typical antipsychotics back to back? Seems like it would increase the risk of extra-pyramidal and cardiac conduction adverse effects.

The relative risk is probably higher, but the absolute risk is still pretty freaking low.

I mix / match Haldol, Reglan, Compazine, Phenergan all the time in young healthy people who smoke bags of weed / day. I'm much more careful if you are > 60

 

[KGflyboy]

The relative risk is probably higher, but the absolute risk is still pretty freaking low.

I mix / match Haldol, Reglan, Compazine, Phenergan all the time in young healthy people who smoke bags of weed / day. I'm much more careful if you are > 60

Yeah I don't know why this bothers me. I realize it's unlikely to be a big deal. I think I'm going to start adding haldol more for these types of uses. I'm just trying to establish my comfort level before I start throwing it at all my pain and vomiting patients with axis 2 disorders, which is actually like a pretty high percentage of the people I see.

I like the indication for its use:
"Audible anything"

 

[thegenius]

Yeah I don't know why this bothers me. I realize it's unlikely to be a big deal. I think I'm going to start adding haldol more for these types of uses. I'm just trying to establish my comfort level before I start throwing it at all my pain and vomiting patients with axis 2 disorders, which is actually like a pretty high percentage of the people I see.

I like the indication for its use:
"Audible anything"

If you start using it carefully you'll get there. For my young patients with chronic cyclic vomiting from weed, distress, etc, I'll usually order IV, labs, LR x1, Ativan 1mg IV, Zofran 8mg just by reading the chart. This is before I even see the patient. Then I go in 1 hour later and assess them, and if they still have more epigastric pain, nausea, vomiting then i'll order either Haldol 5 IM, Phenergan 25 IM, or reglan IV, etc. Usually by the third visit I'm starting to consider low dose ketamine. If I have to go in there a fourth time because of the vomiting, they are getting vecuronium.

Your post reminds me of how I was with phenobarbital for Etoh withdraw. I never knew about it, was scared to use it...then slowly gave it a try. Now I don't even blink. 260, followed by 130 q15-30 minutes.

I find that it acts a little bit more slowly, but it's a more steady calming drug as compared to benzodiazepines.

 

[southerndoc]

Can't wait until droperidol comes back in full force. Knocks out a true migraine in minutes.

 

[GeneralVeers]

Can't wait until droperidol comes back in full force. Knocks out a true migraine in minutes.

Was just told yesterday that droperidol was taken of our formulary by "corporate directive". Oh well, it was a glorious 2 months while we had it.

 

[southerndoc]

That's horrible. EMS is about to start carrying it (under my direction). I love some droperidol.

 

[deleted109597]

I got a "nastygram" email from the regional director who told me I shouldn't use haldol for nausea and abdominal pain in the superfat teenager (who had "fibromyalgia" already).
She called my local director who was like "yeah, that's pretty common actually".
A week later she sent an email out to everyone else about using haldol for CHS and other conditions.



I was left off that email shockingly. I wasn't ever looking for an apology, but to completely avoid me as if I was going to spike the football was pretty comical.

 

[TheSingularity]

I got a "nastygram" email from the regional director who told me I shouldn't use haldol for nausea and abdominal pain in the superfat teenager (who had "fibromyalgia" already).
She called my local director who was like "yeah, that's pretty common actually".
A week later she sent an email out to everyone else about using haldol for CHS and other conditions.



I was left off that email shockingly. I wasn't ever looking for an apology, but to completely avoid me as if I was going to spike the football was pretty comical.

CMG?

Also how did regional director even know / care?

 

[GeneralVeers]

CMG?

Also how did regional director even know / care?

Because all these worthless blobs of flesh like to pretend they are involved in the local sites. Usually once they open their fat mouths to comment, they reveal their ignorance of anything going on.

 

[DrGasPasser]

I got a "nastygram" email from the regional director who told me I shouldn't use haldol for nausea and abdominal pain in the superfat teenager (who had "fibromyalgia" already).
She called my local director who was like "yeah, that's pretty common actually".
A week later she sent an email out to everyone else about using haldol for CHS and other conditions.



I was left off that email shockingly. I wasn't ever looking for an apology, but to completely avoid me as if I was going to spike the football was pretty comical.

Here ya go. Send this to that master clinician of a regional director:

When Cyclic Vomiting Has You Spinning Your Wheels | Emergency Physicians Monthly

Cyclic vomiting and cannabinoid hyperemesis syndromes repeatedly bring patients through the doors of the ED. Here's your clinical refresher. The symptoms patients experience during an acute cyclic vomiting syndrome (CVS) or cannabinoid hyperemesis syndrome (CHS) episode can be difficult to...

epmonthly.com

While it’s not Level 1a evidence, haldol for CVS/CHS is pretty well known.

 

[southerndoc]

I saw a kid today after an MVC. I saw that I had seen him the year prior for cyclical vomiting syndrome. Apparently I had prescribed him Haldol and noted that he refused to stop smoking weed. I don't even remember prescribing it to him. Too funny. Must've been a super busy shift. Gave a dose in the ER and prescribe PO Haldol for nausea/vomiting.

 

[deleted836128]

I saw a kid today after an MVC. I saw that I had seen him the year prior for cyclical vomiting syndrome. Apparently I had prescribed him Haldol and noted that he refused to stop smoking weed. I don't even remember prescribing it to him. Too funny. Must've been a super busy shift. Gave a dose in the ER and prescribe PO Haldol for nausea/vomiting.

That’s funny. Did he use it? Did it help?

 

[deleted836128]

So I’ve talked about my love of Haldol here especially for the intractable migraines and patients with the triad of chronic pain, psych issues, and strange constellation of chronic symptoms no one can figure out. I don’t use it often but I use it for this people. And my favorite attending told me the other day to “be careful when using it” not because of the QT prolongation but “because how will it look if there’s a bad outcome and the case goes to court and you treated a patient’a symptoms with an anti psychotic?” Thoughts on this?

 

[Zebra Hunter]

So I’ve talked about my love of Haldol here especially for the intractable migraines and patients with the triad of chronic pain, psych issues, and strange constellation of chronic symptoms no one can figure out. I don’t use it often but I use it for this people. And my favorite attending told me the other day to “be careful when using it” not because of the QT prolongation but “because how will it look if there’s a bad outcome and the case goes to court and you treated a patient’a symptoms with an anti psychotic?” Thoughts on this?

I hate that argument. As if I would be embarrassed of explaining my clinical reasoning for something I commonly do. “I, as well as many colleagues have been using this medication for years as adjunctive therapy for numerous pain related complaints with significant empirical evidence of benefit. I have utilized it numerous times as an opioid sparing therapy even when patients have a known acutely painful conditions (like kidney stones) with great success. There is also several studies demonstrating its utility for migraines and gastroparesis. My patients are told they are being given an antipsychotic not because I believe they are crazy, but because I believe it is effective for certain pain related complaints.”

 

[deleted109597]

“because how will it look if there’s a bad outcome and the case goes to court and you treated a patient’a symptoms with an anti psychotic?” Thoughts on this?

Well, during the great drug shortage of early 2010s, the FDA and multiple P&T committees came out in support of using haldol as they were out of zofran, reglan, compazine, and other drugs.
So I would simply point to that and say "this is a safe and effective drug".
Not sure what bad outcome you're implying, but it's unlikely to be the drug.


To that effect, I had a guy who once said he was allergic to droperidol. Said he had anaphylaxis. Couldn't remember when. For his chronic pancreatitis, after a lot of discussion with him, we tried haldol. Pain was gone, he felt better. A few hours later he bounced back with mild angioedema. I saw him again. He was lamenting the allergy, because he told me "that was the best I had felt in years".
So I know it works.

 

[littlejuan]

Anyone watching Castle Rock?

Haldol is a wonder drug!

 

[RustedFox]

The PITA at my shop is that Haldol is classified as a "chemical restraint", so it requires the nurse to do q15min re-assessments, which they hate.
I still order it every shift.

 

[thegenius]

So I’ve talked about my love of Haldol here especially for the intractable migraines and patients with the triad of chronic pain, psych issues, and strange constellation of chronic symptoms no one can figure out. I don’t use it often but I use it for this people. And my favorite attending told me the other day to “be careful when using it” not because of the QT prolongation but “because how will it look if there’s a bad outcome and the case goes to court and you treated a patient’a symptoms with an anti psychotic?” Thoughts on this?

My thought is I don't understand what he is getting at.

There is reams of evidence on the use of Haldol in these patients. Books upon books.



Just used it today on a 25 yo woman with Type 1DM, gastroparesis and a real love for the sticky icky. Came in looking like an alien was going to pop out of her stomach. "I NEED SOME PAIN MEDICINE AHAHAHAHAHHAHA ARRHHHGHGHGHGH" First thing I ask the nurse to get was haldol 5mg IM. Pt calmed down, went to sleep, saw her walking around later and asked how she was feeling. Said "I still have some pain." then laid back down and slept some more. Very easy to get labs, very easy to r/o DKA, give fluids, and we can now take our time with her.

Went from 100% distress to 0% distress.

 

[CoolWhipp]

Zyprexa and Droperidol. 2.5 for n/v, 5-10 for headache. 5 for pain. 10 for agitation. IV doses. They are better than reglan and compazine in my experience. They work so well you almost have to be careful about using it that you might discharge a really sick person, patient almost wanted to go home from his HSV meningitis he felt so well. I've gotten rid of SAH pain with 5-10 of zyprexa many many times.

 

[thegenius]

I asked our pharmacist about getting droperidol and apparently the Hospital's provider doesn't have droperidol to buy.

 

[TooMuchResearch]

It's running out already. We still have some but will be out soon with no reorder date yet

I asked our pharmacist about getting droperidol and apparently the Hospital's provider doesn't have droperidol to buy.