iv bag
Haloperidol LACTATE (Haldol ®)
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents
D5W

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]
May dilute all doses to 1 mg/ml
[0 to 50 mg] [50 ml] [As directed]
[51-100 mg] [100 ml] [As directed]
[200 mg] [160 ml] (1 mg/ml)

[See WARNING below]

Stability / Miscellaneous
EXP: 7 DAYS (RT)
Label: Do not Refrigerate.  Protect from light.

Haldol may be given IV push.
Max IV rate (usual): 5 mg/min.

Oral to IV conversion (approximate): oral dose x 0.625 = daily IV dose.


Package Insert - WARNING:

Cardiovascular Effects
Cases of sudden death, QT-prolongation, and Torsades de Pointes have been reported in patients receiving HALDOL. Higher than recommended doses of any formulation and intravenous administration of HALDOL appear to be associated with a higher risk of QT-prolongation and Torsades de Pointes. Although cases have been reported even in the absence of predisposing factors, particular caution is advised in treating patients with other QT-prolonging conditions (including electrolyte imbalance [particularly hypokalemia and hypomagnesemia], drugs known to prolong QT, underlying cardiac abnormalities, hypothyroidism, and familial long QT-syndrome). HALDOL INJECTION IS NOT APPROVED FOR INTRAVENOUS ADMINISTRATION. If HALDOL is administered intravenously, the ECG should be monitored for QT prolongation and arrhythmias.


Micromedex:
1) An initial bolus dose of 10 milligrams followed by continuous infusion beginning as 10 milligrams per hour is recommended. If control is not achieved, the bolus is repeated every 30 minutes, as well as increasing the infusion rate by 5 milligrams per hour. Adjunctive sedative (benzodiazepines) doses should be adjusted as needed or discontinued if possible. After achieving control, infusion rates should be titrated downward by 50% at each interval, seeking eventual return to bolus dosing. Continuous infusion haloperidol should be considered for patients receiving 80 mg of haloperidol daily (given in 8 or more bolus doses) or who receive more than 10 mg/hour over 5 or more consecutive hours. Continuous dosing is also warranted in patients not effectively managed on other sedatives and in those in whom attempted reversal of the cause of agitation has been unsuccessful (Riker et al, 1994a).

2) Initial infusion doses of 2 to 25 milligrams per hour haloperidol by continuous infusion have been cited in individual cases (Seneff & Mathews, 1995); (Dixon & Craven, 1993)(Fernandez et al, 1988).

Other: Continuous infusion: Doses of 3 to 25 mg/hr have been studied in critically ill patients requiring mechanical ventilation.
Continuous infusions have also been used to treat severely agitated critically ill patients: Start 10 mg/hr, adjust as necessary to provide relief from agitation in increments of 5 mg/hr.


DOSAGE AND ADMINISTRATION
There is considerable variation from patient to patient in the amount of medication required for treatment. As with all drugs used to treat schizophrenia, dosage should be individualized according to the needs and response of each patient. Dosage adjustments, either upward or downward, should be carried out as rapidly as practicable to achieve optimum therapeutic control.

To determine the initial dosage, consideration should be given to the patient's age, severity of illness, previous response to other antipsychotic drugs, and any concomitant medication or disease state. Debilitated or geriatric patients, as well as those with a history of adverse reactions to antipsychotic drugs, may require less HALDOL (haloperidol). The optimal response in such patients is usually obtained with more gradual dosage adjustments and at lower dosage levels.

Parenteral medication, administered intramuscularly in doses of 2 to 5 mg, is utilized for prompt control of the acutely agitated schizophrenic patient with moderately severe to very severe symptoms. Depending on the response of the patient, subsequent doses may be given, administered as often as every hour, although 4 to 8 hour intervals may be satisfactory.

Controlled trials to establish the safety and effectiveness of intramuscular administration in children have not been conducted.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Switchover Procedure
An oral form should supplant the injectable as soon as practicable. In the absence of bioavailability studies establishing bioequivalence between these two dosage forms the following guidelines for dosage are suggested. For an initial approximation of the total daily dose required, the parenteral dose administered in the preceding 24 hours may be used. Since this dose is only an initial estimate, it is recommended that careful monitoring of clinical signs and symptoms, including clinical efficacy, sedation, and adverse effects, be carried out periodically for the first several days following the initiation of switchover. In this way, dosage adjustments, either upward or downward, can be quickly accomplished. Depending on the patient's clinical status, the first oral dose should be given within 12–24 hours following the last parenteral dose.

Source: [package insert]
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.