The dose is the same whether po or IM, so if a patient changes his mind and accepts oral meds, it is easy to change course. This means that it can safely be given to patients who are already taking antipsychotics.
It does not cause respiratory depression and so can be given to intoxicated patients. The main advantage of haloperidol is that it is so safe. Haldol has been safely used for this indication (probably) millions of times world-wide. The best overall antipsychotic for rapid sedation of agitated patients in a correctional setting, in my opinion, is good, old haloperidol. Each has advantages and disadvantages that should be considered. They may work even better when given together. I was taught in my Emergency Medicine residency that the benzos were “minor sedatives” and the antipsychotics were “major sedatives.” However, there have been several studies comparing the two when sedating agitated patients, including this 2010 Cochrane Review, and, in fact, both work well. The two main drug classes that have been traditionally used for this type of chemical sedation are the benzodiazepines and the antipsychotics. We do not want respiratory depression or other serious side effects. We would like him to be sedated and drowsy and even go to sleep, but to be easily arousable. Remember that our goal is to sedate the patient so that he can be released from physical restraints. What medications should be used to sedate this patient? He is not hypoxic or hypoglycemic (but if there is a suspicion of this, it is easy enough to get a pulse oximetry reading or a finger stick blood sugar). This patient certainly meets the criteria for chemical sedation. Nobody really expected him to calm down after he is placed in the restraint chair and they are not disappointed. The deputies take him down and strap him to a restraint chair. Of course, he cannot be allowed to continue to hurt himself. He is agitated and belligerent and wants to fight. The word “uncooperative” does not do him justice. There is blood on his face and on the wall.
He cooperated with the booking process, but then, several hours later, began to repeatedly ram his head full force into the wall. Let’s start by setting the stage: Our patient is a 35 year-old man who is angry that he has been arrested in a domestic dispute case.
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