Haloperidol Monotherapy for GI Symptoms at the Emergency Department Decreases Risk for Hospital Admission

A monotherapy of haloperidol was effective for use among patients seeking care at the emergency department for gastrointestinal (GI) symptoms, according to a review of patient records, the results of which were published in Clinical and Translational Gastroenterology.

Patients (N=281) who presented at Temple University Hospital emergency department between 2016 and 2019 with GI symptoms and received haloperidol were retrospectively reviewed for clinical outcomes.

The patients were aged mean 37.3±13.1 years, 65.8% were women, 52.3% were Black, average BMI was 27.1±6.7 kg/m², and 32.4% had diabetes. Patients presented with vomiting and nausea (31.5%), gastroparesis (17.1%), cyclic vomiting (9.8%), unspecified vomiting (7.8%), and intractable cyclic vomiting (5.1%).

The established GI diagnoses were gastroparesis (39.8%), cannabinoid hyperemesis syndrome (28.3%), cyclic vomiting syndrome (10.5%), peptic ulcer disease (5.8%), chronic abdominal pain (3.7%), and gastroesophageal reflux disease (1.7%).

Patients were administered a median dose of 2.5±3.0 mg of haloperidol intravenously (84.6%), intramuscularly (24.4%), or orally (1.2%). Most patients had a single dose, while 10.2% received 2, and 0.5% received 3 doses.

Roughly one-third of patients (33.2%) returned to the emergency department within 30 days, at an average of 11.48±8.97 days after discharge.

Length of stay in the emergency department was associated with age (r =0.13; P =.007) and frequency of haloperidol dose (r =0.13; P =.012). The time between discharge and return to the emergency department was associated with length of stay in the emergency department (r =0.23; P =.007) and age (r =0.17; P =.041).

Hospital admission was increased among patients with gastroparesis (odds ratio [OR], 2.75; 95% CI, 1.79-4.24; P =0.000), diabetes (OR, 2.13; 95% CI, 1.38-3.30; P =.001), cannabinoid hyperemesis syndrome (OR, 1.72; 95% CI, 1.04-2.86; P =.037), and age (OR, 1.03; 95% CI, 1.02-1.05; P =0.000). Return to the emergency department within 30 days was associated with diabetes (OR, 1.54; 95% CI, 1.01-2.34; P =.046).

Fewer patients who received haloperidol as a monotherapy were admitted to the hospital (OR, 0.25; 95% CI, 0.14-0.47; P =0.000) compared with combinatorial therapies.

Most patients (95.61%) reported no side effects from haloperidol.

This study was limited by its retrospective nature, inhibiting investigators’ ability to assess for symptom severity or to what degree haloperidol improved GI symptoms.

The study authors concluded that among patients presenting at the emergency department with GI symptoms, a monotherapy of haloperidol was well tolerated and decreased risk for hospital admission.

Reference

Shahsavari D, Reznick-Lipina K, Malik Z, et al. Haloperidol use in the emergency department for gastrointestinal symptoms: nausea, vomiting, and abdominal pain. Clin Transl Gastroenterol. 2021;12(6):e00362. doi:10.14309/ctg.0000000000000362