Torsade de Pointes Associated with the Use of Intravenous Haloperidol

Wilt, Jeffrey; Minnema, Ann Mary; Johnson, Robert O.; Rosenblum, Andrew M.

doi:10.7326/0003-4819-119-5-199309010-00007

Cited by 116 publications

(33 citation statements)

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“…[2][3][4][5] The effect of intravenous haloperidol on QT interval dispersion has not been previously reported. Some studies have correlated an increase in QT interval dispersion with an increased risk of monomorphic ventricular tachyarrhythmias.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Intravenous Haloperidol on QT Interval Dispersion in Critically Ill Patients: Comparison with QT Interval Prolongation for Assessment of Risk of Torsades de Pointes

Tisdale

Rasty

Padhi

et al. 2001

The Journal of Clinical Pharma

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The objective of this study was to determine the effect of intravenous haloperidol on QT interval dispersion in critically ill patients and to compare increases in QT interval dispersion and QTc intervals in patients who developed haloperidol‐induced Torsades de Pointes versus those in patients who did not. This was a case‐controlled study of 30 critically ill patients who received intravenous haloperidol for delusional agitation. Cases were patients (n = 6) who developed Torsades de Pointes during haloperidol therapy. Controls were patients (n = 24) who did not experience haloperidol‐induced Torsades de Pointes. QTc intervals were measured and QT interval dispersion was calculated. Haloperidol prolonged QTc interval compared to pretreatment values in Torsades de Pointes patients (606 ± 61 ms vs. 501 ± 44 ms, p = 0.007) by a greater magnitude than in patients who did not experience Torsades de Pointes (507 ± 60 ms vs. 466 ± 44, p = 0.01). Twelve‐lead analysis revealed that QTinterval dispersion increased in patients who experienced Torsades de Pointes (from 63 ± 11 to 95 ± 22 ms, p = 0.03) but not in those who did not (62 ± 18 vs. 60 ± 26 ms, p = 0.66). Analysis of precordial leads only showed no significant haloperidol‐associated increases in QT interval dispersion in either group. The odds of developing haloperidol‐induced Torsades de Pointes were highest in patients with QTc interval > 521 ms during haloperidol therapy (odds ratio = 12.0). It was concluded that intravenous haloperidol prolongs QTc intervals in critically ill patients. The degree of prolongation is greater in patients who experience Torsades de Pointes. QT interval dispersion may be increased in patients who develop haloperidol‐induced Torsades de Pointes compared with those who do not. However, these effects are dependent on the method of measurement (12 leads vs. precordial leads). In addition, the odds of haloperidol‐induced Torsades de Pointes are higher in patients with QTc interval prolongation compared with increased QTinterval dispersion. Therefore, QTc inter‐val determination remains preferable to QT interval dispersion as a means assessment of risk for haloperidol‐induced Torsades de Pointes.

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Section: Discussionmentioning

confidence: 99%

The Effect of Intravenous Haloperidol on QT Interval Dispersion in Critically Ill Patients: Comparison with QT Interval Prolongation for Assessment of Risk of Torsades de Pointes

Tisdale

Rasty

Padhi

et al. 2001

The Journal of Clinical Pharma

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“…3,4 Wilt et al observed this type of arrhythmia in four women who received large doses of intravenous haloperidol. 5 In Kay's series of 32 patients and Di Salva's, torsades de pointes occurred mostly in patients with underlying heart disease, 6,7 most frequently ischemic heart disease, in 53% of patients in some series 6 but it is also described in patients with liver diseases 8,9 and in critically ill patients. 10 It has also been described with doses as small as 4 mg. 11 In more than 90% of patients, the initiating event is a premature ventricular beat occurring following an R on T phenomenon as observed in this report.…”

Section: Discussionmentioning

confidence: 99%

Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery

Perrault

Denault

Carrier

et al. 2000

Can J Anesth/J Can Anesth

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“…HAL have usually occurred in critically ill patients, often elderly, in intensive care settings and at doses far in excess of those generally used. Wilt et al (1993) reported four patients who developed torsades after being treated with HAL in doses of 580 mg over 4 days, 170 mg in 24 h, 489 mg in 36 h and 10 mg over 4 h. Dyskinesias, akathisia, akinesia and dystonias, and neuroleptic malignant syndrome are significant clinical issues. HAL is less likely to induce seizures than CPZ.…”

Section: Haloperidol (Hal)mentioning

confidence: 99%

Pharmacological management of aggression and violence

Humble¹,

Berk²

2003

Human Psychopharmacology

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The pharmacological management of violence and aggression is a common and substantial clinical dilemma in the emergency psychiatric situation. A literature search was conducted through PubMed and using the Cochrane Library. This was followed by a manual search of selected literature. Randomised controlled trials were sought that specifically addressed the acute situation, rather than the ongoing management of chronic conditions. There was a paucity of well-controlled data and insufficient evidence to support the use of many agents in emergency situations. Many studies had considerable limitations making comparison difficult. Efficacy data for a range of treatment options exists, including the use of classical and atypical anti-psychotic agents, benzodiazepines and combination therapies. Clinical risk, tolerability and environmental factors need to form part of a careful and considered judgement in the choice of treatment. Safety, tolerability and the potential for a positive experience are major considerations, thus paving the way for long term compliance.

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Torsade de Pointes Associated with the Use of Intravenous Haloperidol

Cited by 116 publications

References 0 publications

The Effect of Intravenous Haloperidol on QT Interval Dispersion in Critically Ill Patients: Comparison with QT Interval Prolongation for Assessment of Risk of Torsades de Pointes

The Effect of Intravenous Haloperidol on QT Interval Dispersion in Critically Ill Patients: Comparison with QT Interval Prolongation for Assessment of Risk of Torsades de Pointes

Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery

Pharmacological management of aggression and violence

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