![]() ![]() Dose adjustment is therefore recommended for patients with hepatic or renal impairment, as well as patients who are elderly. Reminder of dosing recommendations in elderly patientsĮlderly patients may have a lower clearance and longer elimination half-life of haloperidol. Relevant clinical guidance should be consulted for care of these patients.Ĭlinical guidance, especially on dosing and monitoring for patients with delirium, should be referred to such as NICE guidance on delirium, SIGN guidance risk reduction and management of delirium, and British Geriatrics Society guidance on patients presenting with confusion and delirium.ĭuring the coronavirus (COVID-19) pandemic, haloperidol has also been used for the treatment of delirium associated with COVID-19. Haloperidol is contraindicated in patients with Parkinson’s disease and dementia with Lewy bodies. However, in cases of delirium where these methods have failed and the patient is distressed or there is a risk to their safety or those around them, then clinical guidance recommends low-dose, short-term haloperidol unless contraindicated.įull contraindications can be found in the Summary of Product Characteristics (SmPC). Frailty (defined by NHS England as ‘a loss of resilience that means people don’t bounce back quickly after a physical or mental illness, an accident or other stressful event’) can further increase the risk.Ĭlinical guidance recommends that pharmacological interventions for acute treatment of delirium are kept to a minimum with non-pharmacological interventions used first-line. Delirium may also overlap with dementia or other precipitating factors such as polypharmacy or infection, which can be especially relevant in elderly patients. Diagnosis and treatment of newly presenting delirium in elderly people can be challenging as it is often multifactorial.Ĭlinical guidance recommends that patients are reviewed, and screening tools used. ![]() Clinical advice available on treatment of deliriumĭelirium or ‘acute confusional state’ is a common and complex condition that is known to occur more frequently in older people. This advice is consistent with current clinical advice for management of delirium in this population. We issue this reminder to healthcare professionals, especially prescribers of haloperidol, to emphasise the need for special caution when using this medicine in elderly people. However, the review identified that the practical use of haloperidol in patients with delirium is variable and is known to be especially associated with adverse effects of the central nervous system. The review did not identify any new safety concerns relating to use of haloperidol in elderly patients and no changes will be made to the safety advice in the product information. We have made available a Public Assessment Report. We sought advice on the review assessment from the Pharmacovigilance Expert Advisory Group of the Commission on Human Medicines and experts in neurology and psychiatry. The review included safety data from the Yellow Card scheme as well the published literature and current clinical guidance. The MHRA conducted a review of UK safety information for haloperidol in the treatment of delirium in frail, elderly patients. The MHRA received concerns from a patient representative regarding the use of haloperidol for the acute treatment of delirium in elderly people in the UK. Haloperidol is a first-generation antipsychotic authorised for treatment of neurological and psychiatric disorders, including the acute treatment of delirium in adults when non-pharmacological treatments have failed – see the Summary of Product Characteristics (SmPC) for full indications. Review of haloperidol use in elderly patients with delirium
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