Medicines

Always look for and treat direct causes including pain, urinary retention, constipation, etc.  Where these interventions are ineffective or more rapid control is required to reduce the risk of harm to the patient and others, it may be necessary to move to pharmacological management earlier than would normally be considered.  Normally use the SIGN guidance (Pharmacological treatment section), but in more urgent situations refer to the NICE guidance on violence and aggression.

^*unless on the specific advice of a specialist, e.g. mental health liaison.

^**note the BNF max dose for haloperidol is 5mg in 24 hrs, but we would suggest a more conservative approach with max 2mg in 24 hours in the first instance. Where higher dosages are required please seek specialist advice.

Some recommendations may be for medicines prescribed outwith the marketing authorisation (MA) also known as product licence. This is known as ‘off-label’ use.’  Haloperidol is only licensed when used without other drugs that prolong the QT interval (SIGN guideline², NICE delirium guideline⁶).

If patients are treated using the NICE rapid tranquillisation interventions, please monitor for side effects, vital signs, hydration level and consciousness at least every hour until there are no further concerns about the person’s physical health.

In older adults note the British National Formulary maximum dosage for haloperidol is 5mg in 24 hrs, but we would suggest a more conservative approach with maximum 2mg in 24 hours in the first instance. Where higher dosages are required please seek specialist advice.

Note the usual guidance of caution with use of medication in older people, and especially certain medications in people with Parkinson’s disease or dementia with Lewy bodies (eg antipsychotic medication).

Note the usual guidance of caution with use of medication in older people, and especially certain medications in people with Parkinson’s disease or dementia with Lewy bodies (eg antipsychotic medication).