Haloperidol ...

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I had an acutely psychotic patient with an order for IV Haloperidol....

I went to the pyxis...selected haloperidol lactate...it dispensed the med. In reading the vial, it stated "FOR IM ADMINISTRATION ONLY". Great...I thought I had selected the wrong medication...checked the screen...dispensed med was haloperidol lactate. So, I called the doctor and got the route changed to IM administration instead. I emailed pharmacy and told them of the potential problem. The reply I got was...it is ok to use for IV administration. WHAT??!! The vial states NOT FOR IV ADMINISTRATION, FOR IM ADMINISTRATION ONLY!!!! I am NOT GOING TO GIVE IT IV!

HELP:uhoh3: !!! Is this RPh nuts?? I've checked drug guides, the FDA website...anywhere and everywhere....and I can't find a clear answer, so any help you can give me would be greatly appreciated!!!

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Specializes in Oncology/Haemetology/HIV.

Some forms of haldol may be given IV in some hospitals that have policies to permit it. There are cardiac issues involved.

But it many places, it is only given PO or IM, as it is safer.

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in our facility we're not even allowed to use haldol. face it though, sometimes it's necessary and thank goodness we've got one doctor who says "if someone has a problem with my order, tell them to come to me." i agree though, if it says im only i don't give it any other way. we had one doctor order glucagon 50ml im.. i was like ummmmmmmmmm no! she argued with me and said to give it because she said so.... i once again said no way, not gonna happen. told her if she wanted a 50 ml dosage given im, that she could do it. of course, she wouldn't and if she had tried, i would have done all within my power to stop her. she finally listened to the pharmacist on duty and changed the order. meanwhile we had someone who couldn't take anything by mouth, had no access anywhere else, no iv, g-tube or anything... with a blood glucose of 36... sighhh needless to say, we were able to finally convince her to let us start an iv and get his sugar back up. scary time though when a doc won't listen.

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im and po here. i've never seen an iv haldol solution and when i just looked it up, im and po are the only routes mentioned.

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Specializes in Nephrology, Cardiology, ER, ICU.

I have given it both IV and IM. You just have to be very aware that it can prolong the Q-T interval and precipitate Torsades. It is a facility-driven policy.

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yeah thanks. just found a reference to iv administration in an article about meds and vent patients. guess you really can learn something new every day.. lol. yeah i know that's true, especially in this profession but just had to actually say it anyway ;)

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I just put my lawyer cap on and it is all very clear. If the vial states IM only, then you would have a heck of a time convincing the jury you acted in good faith. I have been in many arguements over this drug/route difference of opinion. Stand your ground.

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Specializes in ICUs, Tele, etc..

I too have given this IV and IM and also PO. I have a quick question though, I'm aware that it says IM only on the vial. If you give this IV, and I have before, because a 1 mg IM haldol doesn't do much in my opinion....If you give it IV, would this be considered an "off label" use, and still be ok?

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Specializes in Education, Acute, Med/Surg, Tele, etc.

We don't typically give haldol, and when I have it has been IM. If I came up to a lable that said IM only...I would do exactly what the OP did, call the Rx and talk to the MD personally.

And document document document!

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Specializes in CIC, CVICU, MSICU, NeuroICU.

We have always giving it IM or IV. But then again I work in CCU with cardiac monitor. It's true that Haldol can prolong Q-T interval and could potentially lead to Torsades. I like ativan a lot better though.

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Specializes in Critical Care.
I just put my lawyer cap on and it is all very clear. If the vial states IM only, then you would have a heck of a time convincing the jury you acted in good faith. I have been in many arguements over this drug/route difference of opinion. Stand your ground.

Nurses use drugs in 'off-label' ways by order ALL THE TIME.

The legal test isn't in the official FDA label but what a prudent nurse would do. Several sources cite that IV haldol lactate is an acceptable choice.

A 'prudent' nurse can indeed use a drug in an 'off-label' fashion. We do it all the time.

But, as has been pointed out, several facilities have policies AGAINST this practice and that policy would take priority in a legal case. If you disobey hospital policy, you probably WILL be liable in a legal suit. So, the first order of business if you are concerned about IV haldol is to check your hospital policy.

~faith,

Timothy.

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