Mixing Medications For Emergency Treatments

[anna07banana]

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.

[Little Panda RN, ASN, RN]

New2ER said:

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 you can. I've never seen it precipitate so I've never thought twice about it.

Tonight, a coworker - with whom I've been working the entire time - gave benadryl separate and said she read something back in the mid '90s about not mixing these two drugs. (First, I'm kinda annoyed that I've been working with her over a year, she's seen me mix them and never said anything, but that's besides the point).

Does anyone else mix these in the same syringe and had precipitate or negative outcomes?

We always call the pharmacy if we are not sure if the meds could be mixed together. But I have never mixed benadryl in with any other medications. Not sure why just dont.

[Dave11, BSN, RN]

We do that in the ER all the time. I've never seen/had any problems with this mixture in the 6 years I've been in the ER.

[chaney123]

Our pharmacy gave us a handout of medications that can and cannot be mixed. It's posted in the med room..Ativan can't be mixed with anything. It is much thicker than any other med...as for the Benadryl and Haldol, I know that I've always mixed it but I'll check it on the posted list.

[MedicalLPN, LPN]

I don't mix Ativan with anything, we don't use benadryl for agitation, I would always be afraid I'd have a patient who'd have the reverse reaction of becoming hyper and more agitated due to the benadryl though I guess the Haldol and Ativan would counteract that. We use a ton of Geodon IM where I work and it works EXTREMELY well in fact on my floor we refer to it as Vitamin G lol We also occasionally use Abilify and Zyprexa IM Anyone else use Geodon IM where they work?

[New2ER]

raegreens said:

Hi, I am just wondering about new2er's dosages, where I work Haldol10Ativan2 is a 3ml injection, we give Benadryl separately just to avoid going over 3ml. More often we use cogentin which must be given separately. If our patients don't have a history of dystonia we don't use either one. MedicalLPN- we also use Geodon IM but only if a patient has a documented "allergy" or dystonic reaction to Haldol.

At my current job we generally use Haldol 5, Ativan 2, and Benadryl 50. The benadryl is given both as a sedative and to counteract possible EPS side effects from the Haldol. It does total 3ml. On occassion the doc will order Haldol 10 which would made the injection 4mls and I split it into two syringes, Haldol in one and ativan/benadryl in the other. We don't use Geodon at all and have only recently added zyprexa as an emergency medication. It's still not routinely given.

Geodon can't be given to the patient here until there is an EKG on file that shows no QT abnornmality.

I have discussed this topic with several other nurses and a doc and they all were suprised that haldol and benadryl are not supposed to be mixed. Only one nurse knew about the restriction but stated that it was assumed that those instances are a "one shot deal".

[cjcsoon2bnp, MSN, RN, NP]

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 ?

!Chris

[marshmallowstar, BSN, RN]

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. :)

[Chaser, BSN, RN]

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!

[EarthChild1130]

When I worked inpatient psych we used Benadryl separately but mixed Ativan and Haldol together.

[Mish56, BSN, RN]

We've always given Haldol and ativan together and the cogentin separately. Don't use benedryl IM in emergency, but hey, maybe it works well. Call the pharmacy or check micromedex. Our pharmacists are wonderful! So helpful.

[green12, BSN, RN]

Hi, I am just wondering about new2er's dosages, where I work Haldol10Ativan2 is a 3ml injection, we give Benadryl separately just to avoid going over 3ml. More often we use cogentin which must be given separately. If our patients don't have a history of dystonia we don't use either one. MedicalLPN- we also use Geodon IM but only if a patient has a documented "allergy" or dystonic reaction to Haldol.