Harms from haloperidol for symptom management in palliative care; a post hoc pooled analysis of three randomized controlled studies and two consecutive cohort studies

Symptom control for people with cancer improves quality of life. Haloperidol is a key drug in palliative care and is frequently used for the treatment of delirium, nausea, and vomiting.1 Haloperidol, a butyrophenone, is a more potent D2 receptor antagonist than other antiemetics, such as prochlorperazine, olanzapine, or chlorpromazine. The adverse events associated with haloperidol are like those of the phenothiazines, except that haloperidol potentially causes less sedation and hypotension. However, haloperidol is more strongly associated with extrapyramidal symptoms especially compared with newer drugs such as quetiapine or risperidone, and patients with Parkinson disease or Lewy body dementia may be more sensitive to its adverse events.2 Haloperidol is inexpensive and has several routes of administration. Only a few studies focus on patients with life-limiting illnesses. The aim of this study was to determine whether the doses of haloperidol used in palliative care cause immediate and short-term harms and, if so, what is their severity?