WhiteCoat

Haldol bites the dust

The FDA just came out with an FDA ALERT warning healthcare providers about the use of Haldol.
Based on an Italian study in 2005, there may be a link between Haldol and Torsades de Pointes/QT prolongation. In addition, there were “at least 28 case reports” of Torsades and QT prolongation with Haldol use. Knock me over with a feather.

Now there is a recommendation that EKG monitoring be performed on anyone receiving IV Haldol.

Haldol was approved by the FDA in 1988. Nineteen years and probably tens of millions of doses later we are able to come up with a whole 28 case reports that may link Haldol to prolonged QT syndromes? Impressive.
Notice how the ALERT states

Based on case reports alone, we are unable to estimate the frequency with which QT prolongation or TdP occur following administration of these drugs.

Doesn’t matter. Just blast this medication the same way you blasted Droperidol with no scientific basis.

So now I have some questions.
If the FDA was so concerned for patient safety, why did it wait for two years before posting its FDA ALERT? The study which forms the basis for its ALERT was published in 2005.
Did anyone notice that the Italian study cited used Haldol decanoate – the long-acting version of the drug? No one gives that IV.
Did anyone notice that the study cited by the FDA was sponsored by Johnson & Johnson? Janssen Pharmaceuticals is one of Johnson & Johnson’s partners and makes a product named Zyprexa that competes with Haldol. Zyprexa has sales of more than $2 billion per year. Don’t suppose that sales of Zyprexa will be hurt by the FDA’s shock statement about Haldol usage.

Interesting NY Times article from 2003 showing how these antipsychotic drugs are a huge moneymaker for pharmaceutical companies. The article notes that

For the price of treating one person with Zyprexa at $303 for a month’s prescription, he said, or two on Risperdal, at $159 per month, the state could treat 8 or 10 people with Haldol at $35 per month.

Zyprexa and Risperdal have been linked to early onset diabetes and DEATH, but there is no “FDA ALERT” that we have to do Hemoglobin A1c levels or blood glucose levels before giving them. Risperdal is also linked to strokes, but there is no “FDA ALERT” that we have to do a CT scan on every patient before we give it. Why all the fuss about Haldol?

Want me to stop using Haldol? Here’s my proposal to patients:
Stop coming into my emergency department as an angry drunk or a combative drug abuser. Stop trying to assault me or my staff. Cooperate with us while we try to help you. Then I won’t have to use Haldol on you and everyone will be happy – except maybe Johnson & Johnson.

16 Responses to “Haldol bites the dust”

  1. Nurse K says:

    Take away Haldol and you take away my last vestige of hope for calm overnight shifts.

  2. enrico says:

    OK, stupid med student question here: why would you give a drunk or a strung-out crackhead haloperidol? I understand loss of agitation is a desired effect, but given the MOA (DA antagonism) it doesn’t seem like a rational drug decision. Why not simply give lorazepam (OK, maybe not the best choice if BAC is too high) or the like? Why do ED ppl love Vitamin H so much? I read about y’all giving this all the time to non-proven psychotics, and I never understood why.

    Which leads me to a potentially serious answer to your question, “Why all the fuss about Haldol?” Perhaps the FDA knows it’s a common “go-to” drug for so many things, much moreso than Zyprexa, Risperdal, Seroquel, etc. Does that mean I don’t think the FDA gets regular “servicing” from pharma-lobby whores? Hell no! OK, I’ll stop now. :)

  3. misspudding says:

    I’m not in the medical industry (quite the contrary, I’m an environmental geologist), but I find your attitude refreshing.

    Nice blog.

  4. ERnursey says:

    Conspiracy theories, I LOVE it.

  5. scalpel says:

    “Why would you give a drunk or a strung-out crackhead haloperidol?”

    Because it works. It turns dangerous obnoxious jerks into peacefully snoring little lambs. And it works especially well in combination with ativan.

    Nighty night!

  6. I have been on Haldol for a while now and the docs never even told me about this warning, but I am fine and I am not switching that other stuff is too expensive, and has more side effects. I can’t believe that the FDA is gonna post that alert for something that has yet to be proven. BTW what is QT syndromes?

  7. [...] it’s Haldol. Then it’s Rocephin. The latest generic medications on the hit list are cold remedies. [...]

  8. JEA says:

    I’m curious about the 2005 study that you mention. Where was it published?
    Thanks
    jea

  9. Ron Reeves says:

    I think some of you “caregivers” should take haldol peridol for a couple of months and then see if you can give it to someone else with a clear conscious. The potential side effects are pages long of side effect, side effect. Most people have at least a handful, some are horrible chronic effects that last a lifetime.

    I think the jerks are the ones force feeding this drug.

    The fact is Haldol is generally worse than the original problem. I was force fed this at 18 years old in 1977 by military and it was the worst 3 months of my life. I was literally scared straight and afraid to show any weakness or emotion of any kind for years for fear this would be done to me again. I would rather live under the underpass than take this junk.

    I don’t trust doctors especially psych doctors to this day. I am suspicious of the efficacy of most prescription drugs. In my eyes our medical system looks like something in a sci fi story about a world gone bad. We are in the dark ages of medicine right now and nobody cares. In 50 years what we are doing now is going to look like the medical horrors of the past.

    I would not deny anyone any drug they think helps them (including a long list of banned or illegal drugs). I think its a personal decision left up to the individual. But force feeding drugs can be the same as torturing someone, and often when no crime whatsoever has been committed.

  10. peggy says:

    i would never recommend anyone to take haldol they forced me down in the hospital and comatosed me with haldol never in mylife did i have ceasers i had 2 major grandma ceasers after that please if your listening refuse that medicine it almost took my life. sincerely peggy sue

  11. Jake Olszewski says:

    I take 50mg injections of haldol deconate and i have finally have gotten use to the med after 5 years or so. Luckily I have no side effects from it anymore. But our understanding of the human brain is rudimentary at best. I would love to have a doctor take haldol and feel how horrible
    tardive akathasia is.Maybe then he would think twice before prescribing it to make money for the pharmamcetiucal industry.

  12. Steven says:

    I was forced an injection of haldol in a hospital in Mn just for asking to be discharged. Everyone there got the shot. If that didn’t work they forced shock therapy. I was a rape victim, but they did not believe me. I still cannot believe how I was treated. I have been grinding my teeth ever since. Thanks a lot.

    • MaryBeth says:

      Im so sorry for what happened to you. They just did that to my husband a few minutes ago, I am headed down to hospital to see how he is. He said he was slobering and shaking, tingleing and omg whats next,
      This is horrible treatment…

  13. MaryBeth says:

    OMG I am so scared for my husband….he was taken to the psych ward (stress unit) for over taken his ambien and klonopin because of mental illness from his PTSD. He called me and took all his meds away and shot him full of HALDOL and he said no to it…..can they do that since he said no to it and without my permission>?I am his wife. Doesnt he have rights?This will hurt him in the long run and he is addicted to his Opiates he WAS on and Klonopin. He didnt kill anyone… OMG I need advice like now. We have no family and I know in my heart this is WRONG…..AND WHAT IT QT SYNDROME.. HELP >>??

    • Chris says:

      Get a lawyer and try to sue the hospital. I am currently trying to obtain a lawyer for my brother being forced to take the medication. He has been completely mentally disabled ever since and that was four years ago.

  14. TH says:

    Check the local statutes: if the person is on a psychiatric hold (a legal thing, not a medical thing), there will be very little recourse since the person in question was deemed to be either suicidal, gravely disabled, or dangerous to self/others.

    And use some google-fu for “Long QT Syndrome” – the Wiki on it is not terribly approachable, but the gist can be seen there.

    From ACEP: “Focus on Chemical Restraint” 2013

    “… In conclusion – Haloperidol and lorazepam combination therapy for chemical restraint remains first line for use in medically undifferentiated emergency department patients.”

    Long QT is something we all worry about it despite its rarity and the competing drug companies like to emphasize the bad of their competition.

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