Haloperidol does not reduce delirium in critically ill patients

FDA Highlights by Bruce Sylvester – Treatment with the antipsycotic drug haloperidol does not reduce symptoms of delirium in critically ill patients, UK researchers report.

The research team, led by Dr Valerie Page, consultant in intensive care at West Hertfordshire Hospitals, UK, studied the effect of haloperidol on delirium in 141 critically ill patients on artificial ventilation in Watford General Hospital, Watford, UK.

Seventy-one  subjects received haloperidol treatment for delirium and 70 received a placebo. Dosing with the drug was based on existing clinical practice for the management of delirium. Patients were monitored for adverse drug reactions and for over-sedation.

The researchers reported that, compared to the placebo group, haloperidol had no effect on the number of days spent without delirium or without coma, up to 14 days after initiation of treatment.

Haloperidol treatment did not affect mortality rates, length of stay in critical care or hospital, or number of ventilator-free days up to 28 days after the study began.

However, the investigators did find that patients given haloperidol required less sedation than those given placebo, suggesting that the drug might be helpful for short-term management of acute agitation.

“Despite a limited evidence base, increasing numbers of patients are being exposed to haloperidol for the management of delirium,” Page said. “Our results suggest a commonly used haloperidol dose regimen does not decrease delirium in critically ill patients requiring mechanical ventilation, when commenced early during ICU stay.”

In a linked Comment, Yoanna Skrobik, MD, Lise and Jean Saine Critical Care Chair at the University of Montreal School of Medicine in Montreal, Quebec wrote, “Although haloperidol is used commonly, its use to treat delirium does not seem to be justified.”