A 34 y/o m presents to the ED agitated and combative with the following vitals signs: T 104.6, P 136, BP 198/124. His urine toxicology screen is positive for amphetamines.
What do you give for sedation? Benzos, benzos, benzos…. On the rare occasion when benzodiazepines fail to achieve an adequate level of sedation, either a rapidly acting barbiturate or propofol should be administered.
Why not haloperidol (Haldol)?
Controlled animal experience clearly contraindicates the use of phenothiazines (e.g. prochlorperazine, chlorpromazine) and butyrophenones (e.g. haloperidol, droperidol).
In animal models, these drugs enhance toxicity (seizures) or lethality, or both.
Additional concerns regarding these drugs include their ability to interfere with heat dissipation, exacerbate tachycardia, prolong the QTc interval, and induce torsades de pointes, or precipitate dystonic reactions.
Therefore, although somewhat controversial, haloperidol should be avoided in acute intoxication from cocaine, amphetamines, or other sympathomimetics.
