Following our recent Infomail about the Inspector General’s report about the pervasive (83%) unapproved use of neuroleptics (a.k.a. antipsychotics) for elderly patients in nursing homes, Dr. Louis Caplan , Professor of Neurology Harvard Medical School and Senior Neurologist Beth Israel Deaconess Medical Center, alerted us to the huge overuse of antipsychotics (especially haloperidol) at general hospitals across the nation.
At our request, Dr. Caplan wrote a short but powerful essay (below) in which he makes a strong case against administering Haldol to restless patients who are hospitalized for surgical and / or medical procedures, and for patients in intesive care units because the drug causes extreme harm to patients.
"In stroke patients Haldol and other antipsychotics and central nervous system depressants have been shown to delay and impede.recovery."
Vera Hassner Sharav
Haldol is the most overused drug among patients hospitalized on medical and surgical services and in intensive care units
In hospitalized patients Haloperidol (Haldol) is often used to calm patients who are agitated. Often high doses are used. Haloperidol regularly produces depressed alertness, body and limb stiffness, inertia, apathy, and drowsiness. The drug may remain in the body for days and even weeks depending on the dose and renal and hepatic functions.
These negative effects are more prominent in older patients and those who have brain disease. One dose of Haldol can be disastrous for patients with Parkinson’s and other extrapyramidal conditions.
Many patients become agitated because they are ill. Haldol makes it very difficult to obtain a cogent history or obtain full co-operation during general and neurological examinations so that it slows and interrupts the bedside diagnostic process. The over-sedation and body stiffness become risk factors for pulmonary and urinary infection.
When the sedative effects of Haldol wear off, patients naturally often have rebound hyperactivity. Any sedated individual can become temporarily restless when they are becoming more alert. Unfortunately they then are often knocked down with more Haldol rather than letting the natural course of recovery from sedation transpire.
Haldol has been shown to delay recovery in experimental animals with brain lesions and patients who have had strokes.1-4 Administration of haloperidol blocks amphetamine-promoted recovery in animals, and haloperidol, as well as other butyrophenones (fluanisone, droperidol), transiently reinstates the deficits in recovered animals.1,2
It takes weeks for animals to catch up to controls who have not been given Haldol. In stroke patients Haldol and other antipsychotics and central nervous system depressants have been shown to delay and impede.recovery.
During the 14 year period that I was Chairman of the Neurology department at Tufts and Neurologist-in-chief at the New England Medical Center in Boston, we eliminated completely the use of haldol in hospitalized patients on our neurology service.
Complications of the use of Haldol was one of the most common reasons for neurological referral for consultation in the New England Medical Center. It is also a common reason for referral at the Beth Israel Deaconess Medical Center. In my opinion, this drug should not be used in older surgical and medical patients, especially those with abnormal brains.
1. Feeney DM, Gonzalez A, Law WA. Amphetamine, haloperidol and experience interact to affect the rate of recovery after motor cortex injury. Science 1982;217:855-857.
2. Houda DA, Feeney DM. Haldoperidol blocks amphetamine induced recovery of binocular depth perception after bilateral visual cortex abilities in the cat. Proc West Pharmacol Soc 1985;28:209-211.
3. Goldstein LB. Potential effects of common drugs on stroke recovery. Arch Neurol 1998; 55:454-456.
4. Goldstein LB. Common drugs may influence motor recovery after stroke. The Sygen in Acute Stroke Study Investigators. Neurology 1995;45:865-871.
Louis R Caplan MD
Professor of Neurology Harvard Medical School
Senior Neurologist Beth Israel Deaconess Medical Center Boston