Haldol, Pneumonia, PD

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Why on earth would any one consider giving Haldol to an elderly patient with Parkinson's disease admitted for Pneumonia???? Just because he/she is confused/agitated!!

According to the American Parkinson's disease Association, Haldol use should be avoided in eldery.

There are a lot of meds that "should" be avoided but are prescribed because the benefits outweigh the risk.

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Specializes in Medsurg/ICU, Mental Health, Home Health.

Take my opinion with a grain of salt...but Seroquel is probably a better choice for delirium in this population; however, Seroquel can't be given IV or IM. It's fine if you have an OG, NG or PEG, but if it has to be given PO to a delirious person, that just might not work.

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Specializes in Critical care.
Take my opinion with a grain of salt...but Seroquel is probably a better choice for delirium in this population; however, Seroquel can't be given IV or IM. It's fine if you have an OG, NG or PEG, but if it has to be given PO to a delirious person, that just might not work.

Geodon (given IM) is our preferred alternative to haldol. Getting it ordered instead of haldol is another fight all together, however.

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Specializes in Med/Surg crit care, coronary care, PACU,.

Snarky nurse says: because said doctor is not educated enough to know that haldol is contraindicated in parkinson's, and confusion is a symptom of pneumonia, with associated multifactoral delerium. Sorry, had to get that out.

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Snarky nurse says: because said doctor is not educated enough to know that haldol is contraindicated in parkinson's, and confusion is a symptom of pneumonia, with associated multifactoral delerium. Sorry, had to get that out.

Hmmm...not sure what you are trying the say here!

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Specializes in Medsurg/ICU, Mental Health, Home Health.
Geodon (given IM) is our preferred alternative to haldol. Getting it ordered instead of haldol is another fight all together, however.

Does Geodon have any demonstrated effectiveness in delirium though?

I've been out of MICU for over a year now but our choices for ICU psychosis/delirium were Haldol, Seroquel and Zyprexa.

Interestingly enough (or actually not interesting at all!) I work psych currently and while the vast majority of my patients are on anti-psychotics, I don't have anyone with PD, and (I'm outpatient/community) if someone walks into my office with delirium, I'm sending him or her to the ED, so I don't treat delirium anymore either...

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Specializes in orthopedic/trauma, Informatics, diabetes.

If haldol is contraindicated in parkinson's pts, is there a recommended alternative? We get a lot of elderly pts (ortho floor) with fx hips that are in many stages of delirium and it can be very dangerous for them and for us. It would be nice to be able to suggest the appropriate med to the first year resident, with rationale.

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Why on earth would any one consider giving Haldol to an elderly patient with Parkinson's disease admitted for Pneumonia???? Just because he/she is confused/agitated!!

Why on earth does this make you so upset?

You should ask the provider the rationale. They are usually happy to tell you.

Without more information, I can't answer the question for you.

However, in my experience, if your elderly patient is a danger to himself/herself or to the caregivers, IM Haldol and Benadryl are often given in combination to get them to sleep so that the delirium goes away.

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Does Geodon have any demonstrated effectiveness in delirium though?

I've been out of MICU for over a year now but our choices for ICU psychosis/delirium were Haldol, Seroquel and Zyprexa.

Interestingly enough (or actually not interesting at all!) I work psych currently and while the vast majority of my patients are on anti-psychotics, I don't have anyone with PD, and (I'm outpatient/community) if someone walks into my office with delirium, I'm sending him or her to the ED, so I don't treat delirium anymore either...

Here's the thing - NONE of these mediations actually resolve delirium. They are really for symptom management.

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Specializes in PCCN.
Why on earth does this make you so upset?

You should ask the provider the rationale. They are usually happy to tell you.

Without more information, I can't answer the question for you.

However, in my experience, if your elderly patient is a danger to himself/herself or to the caregivers, IM Haldol and Benadryl are often given in combination to get them to sleep so that the delirium goes away.

I have had pts flip completely out on benadryl. Not sure why.

All antipsychotics can affect QT

Delirium is a crappy thing.

Ive also had a pt in acute delirium and we couldnt give him anything as his Qtc was > 500. was not fun with that pt- he would become violent and try to punch us. And he was ambualtory and an escape risk. Fun, Fun.

Any infection can cause delirium in elderly.

eta- looking up stuff in pubmed- it seems that haldol can cause parkisonian symptomsin a regular person at high doses, so imagine that haldol would aggravate parkisons more. The studies seem to like seroquel or risperdol better.

Ive used seroquel in the past, and it seemed to help one lady we had. still have to watch Qtc though.Not sure why , none of out docs order risperdol

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Specializes in ICU.
Snarky nurse says: because said doctor is not educated enough to know that haldol is contraindicated in parkinson's, and confusion is a symptom of pneumonia, with associated multifactoral delerium. Sorry, had to get that out.

What does any of that have to do with managing a patient's behavior? Regardless of the source of the confusion, if patients are a danger to themselves, we can't just let them get hurt.

We tend to use haldol, zyprexa, and IM Ativan most often, usually in conjunction with soft wrist restraints.

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Specializes in Critical Care.
If haldol is contraindicated in parkinson's pts, is there a recommended alternative? We get a lot of elderly pts (ortho floor) with fx hips that are in many stages of delirium and it can be very dangerous for them and for us. It would be nice to be able to suggest the appropriate med to the first year resident, with rationale.

Haldol isn't absolutely contraindicated in Parkinsons patients but should be used sparingly compared to other patients.

The severity of Parkinson's symptoms correlate to dopamine levels, which is why medications used to treat PD symptoms are dopamine agonists: increasing dopamine levels reduces PD symptoms. The severity of delirium symptoms also correlate to dopamine levels but in reverse; blocking dopamine reduces delirium symptoms. This why new-onset delirium isn't unheard of in patients starting on PD medications.

Both haldol and newer atypical antipsychotics affect dopamine, although through varying pathways, so there isn't any medication that's been shown to be effective against delirium symptoms that won't have any effect on PD symptoms. Atypical antipsychotics have been shown to be somewhat better tolerated in terms of these side effects but they also haven't been proven to work as well as haldol, which is why the Society of Critical Care Medicine continues to recommend haldol as choice for symptom crisis management with atypicals added to hopefully reduce the amount of haldol needed or make it not needed at all.

If a patient is already on sinemet and goes into delirium, reducing the dose would be worth considering and may be all that is needed. But in the end you have to weigh which is worse for patient; their PD symptoms or their delirium symptoms, and manage their dopamine levels accordingly.

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