IV Haldol & Thorazine

[firedoor]

Could someone please provide information on the dosing of IV haldol & IV thorazine?

How much of a concern are arrythmias and how may this risk be minimized?

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[Doc Samson]

Could someone please provide information on the dosing of IV haldol & IV thorazine?

How much of a concern are arrythmias and how may this risk be minimized?

IV thorazine is not the standard of care anywhere, so don't use it.

When a pt needs tranquilization - especially when delirious, IV Haldol is a great choice. Start with 1 or 2 mg, wait 20 mins, if no effect double the dose, wait 20 mins, if no effect double the dose, etc.

So I usually go: 2, 5, 10, 20, 50, 100, etc. Very rarely have to go past the 10 mg dose. Then I schedule the effective dose Q4-6 hours with prns available for breakthrough agitation.

QTc prolongation can be a problem, but Haldol has the lowest per-dose-equivalent risk of QTc prolongation of any of the neuroleptics. Risk can be minimized by repleting K and Mg, d/c-ing other QTc prolonging agents (Reglan, fluoroquinolones, methadone, etc.), and monitoring the pt.

 

[nitemagi]

IV thorazine is not the standard of care anywhere, so don't use it.

When a pt needs tranquilization - especially when delirious, IV Haldol is a great choice. Start with 1 or 2 mg, wait 20 mins, if no effect double the dose, wait 20 mins, if no effect double the dose, etc.

So I usually go: 2, 5, 10, 20, 50, 100, etc. Very rarely have to go past the 10 mg dose. Then I schedule the effective dose Q4-6 hours with prns available for breakthrough agitation.

QTc prolongation can be a problem, but Haldol has the lowest per-dose-equivalent risk of QTc prolongation of any of the neuroleptics. Risk can be minimized by repleting K and Mg, d/c-ing other QTc prolonging agents (Reglan, fluoroquinolones, methadone, etc.), and monitoring the pt.

Haldol does have a dose-dependent QT prolongation effect. If you have any QT prolongation at low dose, you may have more at higher doses. If a patient can't tolerate a dose, try lower dose higher frequency, the extreme version is a Haldol drip.

I've actually seen sub-Q pumps of thorazine for terminal delirium patients in Hospice. Quite amazing actually. These are patients really in the last hours/days of their life, don't resemble themselves anymore, and the family just wants the last hours to be peaceful. SubQ pumps are also nice because if it gets pulled out, it can just be replaced, without the blood, mess, and danger of an IV.