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Comment & Response
July 17, 2018

Prophylactic Haloperidol for Critically Ill Adults

Author Affiliations
  • 1Division of Child and Adolescent Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
JAMA. 2018;320(3):303. doi:10.1001/jama.2018.6041

To the Editor Dr van den Boogaard and colleagues examined the effect of haloperidol on survival among critically ill adults at high risk of delirium.1 We have a number of concerns.

First, we are not aware that haloperidol has a survival indication.

Second, the use of 1 mg and 2 mg of haloperidol given intravenously 3 times daily is equivalent to approximately 6 mg and 12 mg of haloperidol orally. Those doses in general psychiatry are very high starting doses for the treatment of acute psychosis. With such high starting doses, how is it possible that the authors did not find any adverse events, such as acute dystonic reactions or acute akathisia?