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Haloperidol associated with slight increased risk of death in acute myocardial infarction

Comparing the use of haloperidol versus atypical antipsychotics and risk of in-hospital death

Comparing the use of haloperidol versus atypical antipsychotics and risk of in-hospital death


Haloperidol may be more harmful than newer, atypical antispsychotics for older people with myocardial infarction. Picture: Science Photo Library

Antipsychotic medication may be prescribed for people with delirium, although it is known to be associated with an increased risk of mortality. What is not clear is how risk changes for particular groups of antipsychotics.

Nursing home residents are known to be at risk of dying in the first few days of treatment with haloperidol, but newer atypical antipsychotics, such as risperidone, can cause orthostatic hypotension, sedation and anticholinergic side effects including urinary retention.

Adverse neurological events may be more common after short-term use of atypical antipsychotics compared with typical antipsychotics such as haloperidol. Both types can have damaging effects on the cardiovascular system so, for patients admitted to hospital with cardiac problems, it is important to know how delirium can most safely be treated.

This cohort study investigated the comparative safety of antipsychotics for the treatment of agitation related to delirium in patients admitted to hospital with acute myocardial infarction. Data were examined for 6,578 patients who had been treated with haloperidol or the atypical antipsychotics olanzapine, quetiapine or risperidone.

The results showed a small increased risk of death within seven days of initiating haloperidol compared with atypical antipsychotics.

Although haloperidol has been used for a long time to manage agitation it may be more harmful than newer, atypical antipsychotics for older people with myocardial infarction.

Park Y, Bateman B, Kim D et al (2018) Use of haloperidol versus atypical antipsychotics and risk of in-hospital death in patients with acute myocardial infarction: cohort study. BMJ. 360:k1218.

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