Has anyone given Haldol IV?

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I was caring for a very agitated patient the other night. Doctor ordered Haldol 2mg IV. I questioned it as this route is not FDA approved but was told by the pharmacist that this particular form, short acting is given IV frequently across the country. I gave it, no complications arose, but now I question what could have happened if a problem would have happened. Should we give drugs by a route that is not FDA approved? Any input would be greatly appreciated.

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Specializes in cardiac/critical care/ informatics.

I know it is given all the time, I don't understand how it is not FDA approved but widely available as an injectable route. I have given it several times. I guess I will have to research it. :)

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Specializes in Critical Care.

Doctors are allowed to use a drug any way they deem fit after it receives 'FDA' approval. When a doc orders a drug for a purpose not cited on the label, it's called an 'off-label' use of the drug.

Normally, that doesn't apply to 'routes' but purpose of prescription. But, in this case, it IS common for Haldol to be given IV. As such, you pass the legal barrier that concerns you: what would a prudent nurse do? Prudent nurses do give IV Haldol.

I have seen higher doses of Haldol IV cause some compromise. I specifically remember a case where a co-worker was ordered to give 10mg Haldol IV in a recently extubated surgical pt. Nurse was giving it VERY slowly. Doc at bedside says, "Just push it." Nurse says, "No, but you're welcome to . . ." Doc took the syringe from nurse, and 'pushed it'.

And.

5 minutes later, pt bought a brand new ETT.

Just keep in mind that the effects of the drug work faster IV, of course. And with any such drugs, you have to watch closely for effects.

There was a thread here, awhile back, about a new nurse that used a TON of IV haldol one night; I'll see if I can find it.

https://allnurses.com/forums/f8/almost-fired-today-140358.html?highlight=haldol

It's a locked thread, which means it caused enough controversy that you can't contribute to it anymore, but, in my opinion, it is a thread that any new nurse that questions how to give a drug such as this should read. . .

Another thread on the topic: https://allnurses.com/forums/f18/haldol-iv-33555.html#post405565

~faith,

Timothy.

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Specializes in cardiac/critical care/ informatics.

well I just looked it up and it does say not to administer it IV. Learn something new everyday. :flowersfo

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I've given it IV, no problems.

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My hospital policy states nurses on all units are not to give Haldol IV. This policy may have been created because of mix ups between the sodium based version and the decanoate version. The vials of Haldol we recieve on our med/surg floor clearly state on the vial FOR IM USE ONLY. I am aware of one death in regards to Haldol given IV. Cause of death, fatal arrythmia. I never give Haldol IV. For those that give it IV check the vial for route instructions and watch that monitor closely.

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Specializes in Telemetry.

We give Haldol IV. It is my understanding that the research supporting the drug determines the recommended route. The studies done on Haldol in order to pass FDA approval were probably only PO or IM. That doesn't mean that it can't be given IV.

I had a similar scary incident with Vistaril. The order read IV and I gave it IV and another nurse told me, "you NEVER give vistaril IV". Well I panicked, looked it up in the drug book, and sure enough... for IM only! I paged the doctor stat and called the pharmacy while having another nurse hang NS wide open. I had the doctor on the phone in one ear and the pharmacy in the other, both nonchalantly telling me "it's ok to give it IV!". Upon further investigation, I found the reasoning above. Scared the wits out of me but also taught me to always double check and question things when you aren't sure. You did good Lorster.

p.s. in my experience, IV Haldol works for some patients and some it doesn't. Some patients don't show immediate effects but then end up sedate the whole next day. Some get even whackier after getting it. Some it works like a charm. It's a drug to be given cautiously.

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Specializes in Critical Care.

Wanted to point out that Haldol lactate is ok IV; not Haldol decanoate. The decanoate is a longer acting version of the drug.

Not only do you DEFEAT the purpose of IV admin if you use a drug bound in a long acting suspension; that suspension isn't approved for IV use and could do damage.

Also wanted to point out that this whole class of anti-psychotics have an increased risk of QTc prolongation leading possibly to Torsades de Pointe.

Anybody getting IV haldol should theoretically have a baseline EKG and be on a cardiac monitor.

~faith,

Timothy.

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Specializes in Med/Surg, Geriatrics.

I had a similar scary incident with Vistaril. The order read IV and I gave it IV and another nurse told me, "you NEVER give vistaril IV". Well I panicked, looked it up in the drug book, and sure enough... for IM only! I paged the doctor stat and called the pharmacy while having another nurse hang NS wide open. I had the doctor on the phone in one ear and the pharmacy in the other, both nonchalantly telling me "it's ok to give it IV!". Upon further investigation, I found the reasoning above. Scared the wits out of me but also taught me to always double check and question things when you aren't sure. You did good Lorster.

That's very interesting! I've always been told that Vistaril IV can cause hemolysis. I'll look for further information.

I also agree with your observations about Haldol IV. I do not care for it all as much of the time, it either increases agitation or simply builds up and the patient ends heavily sedated hours later.

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Specializes in Critical Care.
I also agree with your observations about Haldol IV. I do not care for it all as much of the time, it either increases agitation or simply builds up and the patient ends heavily sedated hours later.

Yes, and I'm a firm believer that haldol shouldn't be a 'PRN' drug.

Here's what happens more than I can count (I work nights). Agitated pt gets several doses of haldol all night long for severe agitation. FINALLY they konk out about 5am.

I give report and go home.

I come back to this report: "I didn't have to do a thing for him/her; they slept like a baby all day."

YEAH RIGHT. Only to be up all night and agitated because they didn't get an ATC dose of that drug.

Talk about encouraging ICU psychosis!

~faith,

Timothy.

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Specializes in Med-Surg, Wound Care.

I saw the result of Vistaril given IV by another nurse. The patient died secondary to hemolysis. I would NEVER give it IV regardless of a doctor saying it was OK. It says specifically on the drug insert that it is for IM use ONLY and NOT IV!

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Specializes in Neuro ICU, Neuro/Trauma stepdown.
There was a thread here, awhile back, about a new nurse that used a TON of IV haldol one night; I'll see if I can find it.

https://allnurses.com/forums/f8/almost-fired-today-140358.html?highlight=haldol

It's a locked thread, which means it caused enough controversy that you can't contribute to it anymore, but, in my opinion, it is a thread that any new nurse that questions how to give a drug such as this should read. . .

boy, that one was a doozy. :eek: ...as soon as i saw this thread, i was hoping someone had posted the link!!

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