Mixing medications for emergency treatments - page 2

I've been working in psych for almost 2 years. I've been putting haldol, benadryl and ativan in the same syringe for the entire time I've been working this specialty. I remember asking about this when I first started and told... Read More

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    I know this is an old blog, but we call that a B52, and we mix it all!
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    At my facility we use Thorazine, Haldol, Benadryl, Ativan and Cogentin IM. Geodon is usually PO and needs and EKG first before we give it to any of our kids. Here is the one syringe chart our pharm. made for us.

    Thorazine can be combined with Benadryl or Cogentin
    Haldol can only be combined with Ativan
    Ativan can only be combined with Haldol
    Benadryl can only be combined with Thorazine
    Cogentin can only be combined with Thorazine

    I hope that helps

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    Halodol and benadryl together will participate out if left long enough. I work corrections and one of the new nurses drew them up but it took a while (45 minutes?) for the COs to roll in and restrain for med administration. The nurse retrieved the syringe from the med room and they had obviously reacted. We now have a large sign on the cabinet that says not to mix.
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    At my facility, we do combine Haldol and Ativan together and give Benadryl by itself.
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    According to my drug book benedryl is not syringe compatible with much. This includes haldol and ativan. Haldol and ativan however are compatible. I ussually use two seperate syringes. We call that a B52 as well. I much prefer giving zyprexa 10mg most of the time however. Works sooooo fast!
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    I am a psychiatric nurse with background in inpatient crisis stabilization and corrections. This question came up when I was asked why Haldol, Ativan, and Benadryl can't go in the same syringe.
    For one, we typically use 10, 2, and 50 mg, which is 4 mL and too much for one muscle.
    And for two, Benadryl never gets mixed with Haldol in the same syringe: precipitate forms in about 5 minutes. The pH is changed which may alter the effectiveness of one or both medications (depending on what the Benadryl is mixed with) resulting in decreased or increased effects and may cause irritation and possible damage to the injection site.
    Many times since this is given as an ETO, the cocktail does not sit out for that long, but it still precipitates whether it is in the syringe or in the muscle!
    Also, Haldol is compatible with Ativan, but not Valium. When Ativan was nationally back-ordered in the beginning of 2012, we had to order Valium to replace it. That meant there were 3 syringes being used to deliver Haldol, Valium, and Benadryl.

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