(3/3) The major potential adverse effects of acute one-time dose Haldol administration are exceedingly rare. One of these is Q-T prolongation that can, potentially, cause dysrythmias. Another is Neuroleptic Malignant Syndrome. Both of these are very rare, however, and the risk is far less than the risk of prolonged physical restraint. Haldol has also been reported to lower the seizure threshold, but this is controversial. The one reasonably common adverse effect of acute IM Haldol administration is a dystonic reaction. Dystonic reactions involve involuntary muscle contractions usually in the neck, shoulders or face, but also elsewhere. It can also manifest as akesthesia, which can be thought of as a case of restless legs from hell. We are not talking here about Tardive Dyskinesia. Tardive Dyskinesia is also involuntary muscle contractions but these occur after years of neuroleptic medication use and are irreversible. Acute dystonic reactions are easily reversible, using an antihistamine, like Benadryl. Unlike tardive dyskinesia, dystonic reactions are a nuisance, trivial and easily treated. Because of the possibility of a dystonic reaction to IM Haldol, some practitioners give Benadryl 50mg IM at the same time as the Haldol. I do not do this for the following reasons: -The dystonic reactions from Haldol tend to occur the day following the IM injection. Benadryl is so short acting that it is gone by then. Theoretically, then, it may not be effective in reducing dystonic reactions. This has never been studied, as far as I know. -Only 1 in 6 or 7 patients who receive a single Haldol injection will develop dystonia. If you give Benadryl to everyone, you are treating the majority of patients needlessly. -Benadryl has its own set of ill effects and side effects.If a patient does develop dystonia the next day, 50mg of Benadryl given orally will solve the problem quickly at that time. That is when I prefer to treat these nuisance reactions. The standard adult dose of Haldol for rapid sedation is 5-20 mg IM. Source : jaildoctor.com @medicalcortex #medstudents #medical #nurse #medicalstudent #lsd #hallucinations #drugs #f4f #l4l #premed #usmle
