I have sent the following as a Freedom of Information request to 14 NHS Boards in Scotland. All the responses, including tables of statistics, can be read here.
7 November 2014.
Dear NHS Board,
I am writing as part of a Freedom of Information request regarding statistical details of the prescribing of the antipsychotic medication generically called HALOPERIDOL. It may be that the all of the information that I request is already available through a publicly accessible database and if so could you please direct me to this.
The reason I write is that I am aware that Hospital Guidelines/Protocols for acute agitation, psychosis, behavioural or psychological disturbance generally seem to include Haloperidol as the first-line pharmacological treatment of choice, given either orally or intramuscularly.
This week in the British Medical Journal the following paper has been published: “Change Page: “Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia” This refers to individuals who may be diagnosed with dementia, but I am aware that prescribing of Haloperidol, as part of Hospital Guidelines/Protocols is also part of management of Delirium.
I am aware that prescribing of Haloperidol is also routinely part of protocols in those aged under 65 for acute or chronic agitation, psychosis, behavioural or psychological disturbance.
Could you please answer the following questions as completely as possible:
1. For the last 5 years (2009 to 2013 inclusive) could you confirm the quantity of Haloperidol issued to cover all acute and community hospitals in your NHS Board area as per each strength:
ORAL TABLET HALOPERIDOL
ORAL LIQUID HALOPERIDOL
2. Can you supply any protocols/guidelines in place for your NHS Board area that include Haloperidol as part of a treatment pathway.
- Can you confirm if you have a protocol for Delirium and if it includes recommendation of Haloperidol?
- Can you confirm if you have a protocol for Dementia and if it includes Haloperidol as a treatment option for “BPSD” (Behavioural and Psychological Symptoms of Dementia)
- Can you confirm when each protocol was first issued?
- Can you confirm if Haloperidol is ever prescribed in those under 16 years of age?
I am grateful for your help.
Peter J Gordon
This viewpoint was published in Lancet Psychiatry, September 2014:
The following pathway was developed by the Scottish Delirium Association in collaboration with Healthcare Improvement Scotland and its use has been widely promoted to healthcare staff:
This is a complicated pathway. Here is the section on treatment of delirium symptoms:
Update, 5th October 2016. The following was published on the front page of the Scotsman newspaper: "Mental health prescriptions hit ten-year high"
The figures are from the Scottish Government and can be accessed here.
3 Replies to “Hospital prescribing of Haloperidol in your NHS Health Board area”
Reblogged this on Chrys Muirhead .
Reblogged this on Chaotic Pharmacology and commented:
Very interesting post –> Reblogged on chaoticpharmacology.com
Haloperidol is also the first-line of pharmacological treatment for patients with acute agitation in Colombia. It is frequently combined in the same syringe with midazolam, and then it is administered by the IM or IV route. About three years ago I presented a lecture at the Psychiatric Hospital San Isidro (Cali, Colombia) in which I adviced against this practice because of the insufficient evidence supporting the combination of these 2 drugs (i.e., haloperidol plus midazolam) for acute agitation and psychosis. Nonetheless, I am aware that this practice has not been abandoned and it is being used today across diferent hospitals and clinics in Colombia.