Recommended medicines: HALOPERIDOL
Injection: 5 mg in 1‐ml ampoule.
Oral liquid: 2 mg/ml.
Solid oral dosage form: 0.5 mg; 2mg; 5 mg
• Delirium (confusion) is very common in the terminal stages of advanced disease and is associated with a short prognosis. Features suggested being highly specific to acute delirium states are acute onset, fluctuating course, disorganized thinking, inattention, memory impairment and disorientation.
• Delirium may be hyperactive (presenting with agitation, hyper arousal, and restlessness), or hypoactive (presenting with drowsiness, lethargy and reduced levels of arousal), or a mixed pattern in which the symptoms fluctuate between hyperactive and hypoactive.
• Management of delirium comprises identification and wherever possible treatment of possible underlying cause(s):
o Organ failure
o Fluid or electrolyte disturbance
• Delirium is commonly caused by medicines and the patient’s current medicines should be reviewed before pharmacological management is initiated.
• When treatment of the underlying cause(s) of delirium is not possible or unsuccessful, pharmacological management is necessary. Causal treatment may not be indicated in patients with limited prognosis and pharmacological symptomatic therapy has to be initiated without delay.
is considered as first choice therapy in the management of delirium during the terminal phases of disease.
has been shown to be effective in the management of both hyperactive and hypoactive delirium in adult patients during the terminal phases of disease. However, the amount of evidence is limited.
A two controlled studies haloperidol was as effective as clopromazine
, but significantly more effective than lorazepam
Considering the lack of evidence from clinical trials, the recommendation for haloperidol is based on clinical expertise. Expert opinion strongly supports the use of haloperidol
for treatment of delirium in adults.
Additional supporting information for this drug:
l has an oral bioavailability of 60-70%
• Onset of action 10-15 minutes if given SC; >1 hour if given orally.
• The time to peak plasma concentration is 10-20 minutes subcutaneously and 30-40 minutes if given orally.
• Duration of action up to 24 hours, sometimes longer.
• The use of haloperidol
carries the risk of extrapyramidal side-effects. When compared with chlorpromazine
has less effect on the cardiovascular system.
does not have any antimuscarinic properties
is widely available and at low cost
Despite the absence of good quality clinical trials, haloperidol
is widely used in the management of delirium in palliative care.
Adapted from Radbruch L et al. Essential medicines in palliative care - An application for the 19th WHO Expert committee on the selection and use of essential medicines. Kindle Edition, 135 pages. Published June 5th 2013 by IAHPC Press. Available at https://www.amazon.com/Essential-Medicines-Palliative-Care-Application-ebook/dp/B00D7S2D0C