Torsades de Pointes Associated With Intravenous Haloperidol in Critically Ill Patients

ArticleinThe American Journal of Cardiology 81(2):238-40 · January 1998with5 Reads
DOI: 10.1016/S0002-9149(97)00888-6 · Source: PubMed
Abstract
In this retrospective case-control study, 8 of 223 consecutive patients (3.6%) treated with intravenous haloperidol developed torsades de pointes, and were compared with 41 patients randomly selected as controls. The likelihood of torsades de pointes associated with intravenous haloperidol is significantly greater in patients receiving > or = 35 mg over 24 hours or in those with a QTc interval of >500 ms, or both.
    • "Case report results and a systematic analysis of the literature have shown that haloperidol can cause QT prolongation and TdP (Hanks et al., 2004; Glassman and Bigger, 2001). These events were observed with both oral and intravenous formulations at doses considered therapeutic (Perrault et al., 2000; Kriwisky et al., 1990), in both psychiatric and non-psychiatric patients (Glassman and Bigger, 2001; Sharma et al., 1998). Among the molecular mechanisms suggested to explain the effects of haloperidol on the heart is the blockade of K+ channels that are responsible for the repolarizing current IKR (inward rectifier ) of cardiac monophasic action potential (Hanks et al., 2004; Metzger and Friedman, 1993 ). "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Cardiac complications in cancer patients have been a significant medical problem in the last few years. Cardiosafety profile of most novel approved drugs, in cancer patients, is required by regulatory authorities. Risk of proarrhythmic effect associated with a new drug, in fact, is usually evaluated with specific studies conducted in agreement with ICHE14 guidelines. In this overview, we detailed the cardio safety profile of antiemetic drugs. In particular, we focused on data of 5HT3-RA drugs used for prevention of chemotherapy-induced nausea and vomiting in the oncology setting. Methods: A literature search was conducted using the PubMed database to identify studies reporting arrhythmic complications of antiemetic drug used in oncology. Results and conclusion: Most of the antiemetic drugs have been approved by regulatory authorities when ICHE14 guidelines were not issued, so the cardiotoxicity of those drugs has been defined with the post-marketing authorization pharmacovigilance activity. We reviewed the cardiotoxicity data of major antiemetic and adjuvant agents, providing a general overview and recommendations about their use in medical oncology.
    Article · Apr 2016
    • "Haloperidol has a number of potential side effects namely akathesia, extrapyramidal symptoms, neuroleptic malignant syndrome, and cardiac arrhythmias.[15] The risk of developing Torsades de Pointes is increased in patients receiving doses of 35 mg/d or higher.[16] Haloperidol at doses 1-2 mg showed no significant effect of QT interval.[1718] "
    [Show abstract] [Hide abstract] ABSTRACT: Haloperidol has an established role in nausea and vomiting prophylaxis and possible effects on multiple aspects of postoperative recovery including pain and sedation. The purpose of this study was to evaluate the effects of low-dose intraoperative intravenous haloperidol on quality of recovery (QoR) and pain control after general anesthesia and surgery. Ninety eight American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective general, gynecologic or orthopedic surgery under general anesthesia were enrolled. Participants were randomly allocated to receive either haloperidol 2 mg or sterile water intravenously after induction of anesthesia. All patients were given elastometric morphine patient-controlled analgesia (PCA) pump for pain control after the surgery. Post-operative QoR was evaluated within 20 min in the recovery room and 6 h post-operatively. Pain intensity and demand for additional analgesic was measured in the 6(th) post-operative hour. The QoR score in two measurements was not statistically different between the two groups. Haloperidol significantly reduced the nausea in the recovery. The visual analog scale pain score showed that the severity of pain in the haloperidol group was more than the placebo group (4.7 ± 2.4 vs. 3.8 ± 2.5, P = 0.05). Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.
    Full-text · Article · Nov 2013
    • "Potential side effects of haloperidol include extra pyramidal symptoms, drowsiness, agitation, and ventricular arrhythmias. The latter are extremely rare (only case-reports are published22232425) and dose dependent. With the haloperidol dosage that will be used in the present study (3x1 mg or 3x2 mg intravenously daily), no relevant side effects are expected, regardless of underlying condition, organ dysfunction, and concomitant medication. "
    [Show abstract] [Hide abstract] ABSTRACT: Delirium is a frequent disorder in intensive care unit (ICU) patients with serious consequences. Therefore, preventive treatment for delirium may be beneficial. Worldwide, haloperidol is the first choice for pharmacological treatment of delirious patients. In daily clinical practice, a lower dose is sometimes used as prophylaxis. Some studies have shown the beneficial effects of prophylactic haloperidol on delirium incidence as well as on mortality, but evidence for effectiveness in ICU patients is limited. The primary objective of our study is to determine the effect of haloperidol prophylaxis on 28-day survival. Secondary objectives include the incidence of delirium and delirium-related outcome and the side effects of haloperidol prophylaxis. This will be a multicenter three-armed randomized, double-blind, placebo-controlled, prophylactic intervention study in critically ill patients. We will include consecutive non-neurological ICU patients, aged >=18 years with an expected ICU length of stay >1 day. To be able to demonstrate a 15% increase in 28-day survival time with a power of 80% and alpha of 0.05 in both intervention groups, a total of 2,145 patients will be randomized; 715 in each group. The anticipated mortality rate in the placebo group is 12%. The intervention groups will receive prophylactic treatment with intravenous haloperidol 1 mg/q8h or 2 mg/q8h, and patients in the control group will receive placebo (sodium chloride 0.9%), both for a maximum period of 28-days. In patients who develop delirium, study medication will be stopped and patients will subsequently receive open label treatment with a higher (therapeutic) dose of haloperidol. We will use descriptive summary statistics as well as Cox proportional hazard regression analyses, adjusted for covariates. This will be the first large-scale multicenter randomized controlled prevention study with haloperidol in ICU patients with a high risk of delirium, adequately powered to demonstrate an effect on 28-day survival.Trial registration: Clinicaltrials.gov: NCT01785290.EudraCT number: 2012-004012-66.
    Full-text · Article · Nov 2013
Show more