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Discussion

B52 cocktail

I understand that Benadryl, Ativan, and Haldol are not compatible when given in the same syringe IV push.

However, is it safe to give when they are mixed in the same syringe and given IM?

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    • Solved by Kenneth Oja

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    Why do you think the three mixed in the same syringe for IV push are incompatible? Once you determine that then think about how they would be compatible mixing them in a syringe and delivering the medications another method.

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    I believe haldol and ativan are compatible, at least for IM injections, not sure about IV, but a lot of facilities stay away from haldol ivp unless pt is on a monitor anyways. I always do my benadryl separate, however its been so long that I've been doing it I don't remember if its because pharmacy said to, or if I was trained that way or what.

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    • Experts

    Haldol and benadryl form a precipitant within 5 min. They are not to be mixed.

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    • Experts

    Haldol and Ativan are compatible.

    Ativan and Benadryl are compatible.

    Haldol and Benadryl are not compatible.

    So you are not able to give the B52 (or its variations) in one syringe: you will need at least two.

    Benadryl really can't be mixed with much. Many of the nurses I've worked with make it a practice to give it separately even if it is compatible with another med.

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    How about straight Geodon or Zyprexa? Quite effective.

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    How about straight Geodon or Zyprexa? Quite effective.

    I do think Geodon is pretty effective, we usually do Geodon and Ativan though. We hate when the docs order Zyprexa IM most of the time because for the majority of our patients it doesn't ever phase them. I also tend to like the B52 better for emergencies because it can be torture waiting for the Geodon or Zyprexa to dilute.

    Also like others stated, we usually mix the Haldol and Ativan and then give the Benadryl separate.

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    I agree about the Zyprexa IM. It totally wears off in a couple of hours. Not effective for psychiatric emergencies with extreme violent agitation.

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    Geodon is very effective for agitation secondary to the DTs.

    Many years ago we gave a ten four over and out. 10 of haldol, 4 of ativan and 50 of benadryl.. This was only for the worst psychotic violent and truly dangerous patients in the ER.

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    I wish we could do a B52 cocktail, but our physicians will not do it. It is either haldol or ativan and not both. I have seen some give geodon with good results. I wish they would think about using that more.

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    Geodon is very effective for agitation secondary to the DTs.

    Many years ago we gave a ten four over and out. 10 of haldol, 4 of ativan and 50 of benadryl.. This was only for the worst psychotic violent and truly dangerous patients in the ER.

    We've done 10-2-50 before but not 10-4-50. That sounds wonderful.

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    • Experts
    We've done 10-2-50 before but not 10-4-50. That sounds wonderful.

    10/4/50 does work miracles on even the most psychotic patients.

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    • Columnist
    • Solution

    The safety and efficacy of combining different medications can vary depending on the types of medications, the patient's medical history and diagnoses, and the intended therapeutic outcome. It's also your responsibility as a nurse to verify if there are any interactions before you combine them and administer to the patient. 

    This is a great question to ask a pharmacist or to look up in your Drug Guide for Nurses. Your hospital may also have free access to one of the many online medication indexing databases, like Micromedex, where you can easily check drug compatibility. That's what I always used as an ICU nurse!

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