Torsade de Pointes Associated with the Use of Intravenous Haloperidol

This study presents four cases of haloperidol-associated torsade de pointes developing in intubated patients with intensive-care-unit delirium and discusses furosemide, penicillin G, methylprednisolone, digoxin, terazosin, and nitroglycerin.

Abstract

Brief Reports1 September 1993Torsade de Pointes Associated with the Use of Intravenous HaloperidolJeffrey L. Wilt, MD, Ann Mary Minnema, MD, Robert F. Johnson, MD, and Andrew M. Rosenblum, MDJeffrey L. Wilt, MDFrom St. Mary's Health Services and Blodgett Memorial Medical Center, Grand Rapids, Michigan., Ann Mary Minnema, MDFrom St. Mary's Health Services and Blodgett Memorial Medical Center, Grand Rapids, Michigan., Robert F. Johnson, MDFrom St. Mary's Health Services and Blodgett Memorial Medical Center, Grand Rapids, Michigan., and Andrew M. Rosenblum, MDFrom St. Mary's Health Services and Blodgett Memorial Medical Center, Grand Rapids, Michigan.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-5-199309010-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Intensive-care-unit delirium requires rapid treatment to prevent morbidity [1]. Intravenous haloperidol (Haldol, McNeil Pharmaceuticals, Spring House, Pennsylvania) has been used frequently in recent years to combat intensive-care-unit delirium. Its advantages include minimal cardiac effects, even at doses greater than 100 mg/d [2]. We present four cases of haloperidol-associated torsade de pointes [3] developing in intubated patients with intensive-care-unit delirium.Case ReportsPatient 1A 39-year-old woman with bacterial meningitis developed acute congestive heart failure on hospital day 20 and required reintubation and intravenous haloperidol (5-mg increments) and lorazepam (Ativan, Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) administration for sedation. Progressive Q-T interval widening was ...References1. Tesar GE, Stern TA. Rapid tranquilization of the agitated intensive care unit patient. Journal of Intensive Care Medicine. 1988; 3:195-201. Google Scholar2. Sanders KM, Minnema Am, Murray GB. Low incidence of extrapyramidal symptoms in treatment of delirium with intravenous haloperidol and lorazepam in the intensive care unit. Journal of Intensive Care Medicine. 1989; 4:201-4. Google Scholar3. Jackman WM, Friday KJ, Anderson JL, Aliot EM, Clark M, Lazzara R. The long QT syndromes: a critical review, new clinical observations, and a unifying hypothesis. Prog Cardiovasc Dis. 1988; 31:115-72. Google Scholar4. Kay GN, Plumb VJ, Arciniegas JG, Henthorn RW, Waldo AL. Torsade de Pointes: the long-short initiating sequence and other clinical features: observations in 32 patients. J Am Coll Cardiol. 1983; 2:806-17. Google Scholar5. Fowler NO, McCall D, Chou TC, Holmes JC, Hanenson IB. Electrocardiographic changes and cardiac arrhythmias in patients receiving psychotropic drugs. Am J Cardiol. 1976; 37:223-30. Google Scholar6. Laakso M, Aberg A, Savola J, Pentikainen PJ, Pyorala K. Diseases and drugs causing prolongation of the QT interval. Am J Cardiol. 1987; 59:862-5. Google Scholar7. Khan M, Logan KR, McComb JM, Adgey AA. Management of recurrent ventricular tachyarrhythmias associated with QT prolongation. Am J Cardiol. 1981; 47:1301-8. Google Scholar8. Zee-Cheng CS, Mueller CE, Seifert CF, Gibbs HR. Haloperidol and torsades de pointes (Letter). Ann Intern Med. 1985; 102:418. Google Scholar9. Fayer SA. Torsades de pointes ventricular tachyarrhythmia associated with haloperidol (Letter). J Clin Psychopharmacol. 1986; 6: 375-6. Google Scholar10. Kriwisky M, Perry GY, Tarchitsky D, Gutman Y, Kishon Y. Haloperidol-induced torsades de pointes. Chest. 1990; 98:482-4. Google Scholar Author, Article, and Disclosure InformationAuthors: Jeffrey L. Wilt, MD; Ann Mary Minnema, MD; Robert F. Johnson, MD; Andrew M. Rosenblum, MDAffiliations: From St. Mary's Health Services and Blodgett Memorial Medical Center, Grand Rapids, Michigan.Corresponding Author: Jeffrey L. Wilt, MD, Section of Pulmonary and Critical Care Medicine, P.O. Box 9166, West Virginia University, Morgantown, WV 26506-9166.Acknowledgments: The authors thank David Vidro for help with figure production and Dr. Angela Tiberio for help with manuscript preparation. 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