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Paper Chase 3 – Haloperidol - The Once and Future King of HUGS

Sanjay Arora, MD and Mike Menchine, MD
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04:09
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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01:03

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EM:RAP 2017 September Written Summary 760 KB - PDF

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Mario P., MD -

I just used 2.5 mg IM Haldol on one of our problematic gastroparesis frequent fliers and it worked so well she asked me for a script for it. I could not be more excited about this without hurting myself.

Steve D. -

I looooove using haloperidol for gastroparesis, cyclical vomiting, and refractory headaches. Especially if I suspect there might be a little psych component to it. Anecdotally, it works pretty well

Adam A., M.D. -

When droperidol was sadly taken from us we just substituted in haloperidol instead. We use it IM and IV for not only gastroparesis/cyclic vomiting, but also migraine, and numerous other types of chronic pain. That was 4 years ago.

Adam A., M.D. -

Other than the occasional mild dystonic reaction, haloperidol works great for a large variety of chronic pain where I want to avoid opiates or benzos. Most of our docs give it with some Benadryl so the dystonic reactions are rarely an issue. I have also experienced patients getting such good relief from it that they ask for a script for home or request it the next time they come to the ED.

Rabbott -

Back in the 70's, when haloperidol and droperidol were just coming onto the market (I was also just coming onto the market), my understanding was that these two butyrophenones (still the only two in USA) were developed by different companies. Despite near identical properties (though different dosing), one company applied for and received approval as an antipsychotic, while the other company went for approval as an antiemetic and anesthesia adjunct. But, over the decades, depending on availability, the two chemically related drugs have been used to some degree interchangeably. During the epidemic that was initially thought to be cyclic vomiting (probably largely cannabinoid hyperemesis), some of us by serendipity noted the exceptional efficacy of haloperidol (droperidol is hard to come by in current America) and extended its use to diabetic gastroparesis with similar efficacy.

Rabbott -

A note about side effects. The dystonic reactions tend to be late occurrences - these are the folks who return the next day with an oculogyric crisis. But, in real time, akathesia is the common side effect - maybe 30-40% if you actually ask people if they got anxious or restless. The severe akathesia is the person who says that they are no better, but want to go home immediately anyway, or rips out there IV and runs out the doors. Benadryl seems to help somewhat with akathesia prevention and treatment, but the older psychiatric literature found benzos to be superior (that's my experience) - but, it doesn't seem to have shown up in the EM literature. On the other hand, giving haloperidol without an attempt to prevent akathesia is superb for shortening length of stay statistics - those folks want out of the ED right now.

René R. -

Love it 👍

-Biased 2¢

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