Efficacy and Safety of Haloperidol in the Prevention and Management of Delirium in Medical Inpatients: An Umbrella Review of Systematic Reviews.

Objective: Delirium occurs in up to 31% of general hospital patients in the medical, surgical, or critical care wards. Agitation is common during hyperactive delirium, which poses a risk to themselves, other patients, or staff. Evidence for using oral or parenteral haloperidol from randomized controlled trials and published systematic reviews shows divergent findings, ranging from good response to no difference compared to placebo, despite its popularity in routine clinical use. We decided to perform an umbrella review of systematic reviews on the efficacy and safety of haloperidol in delirium.

Collection and analysis of data: This protocol was registered with PROSPERO CRD42024502020. We searched PubMed, Ovid MEDLINE, and PsychINFO for systematic reviews with meta-analyses published in English only over the previous 20 years. These were searched under title, abstract, and Medical Subject Headings (MeSH) terms as applicable. We used Assessing the Methodological Quality of Systematic Reviews 2 to assess the quality of the articles. Ten systematic reviews were finally selected for review that focused on either preventing or treating delirium. The summary of results did not find that haloperidol is effective in preventing or treating delirium, though all included reviews found it a safe drug to use. Heterogeneity from I ² statistics varied from a moderate to a high degree and may be attributable to population, outcomes, and setting variations.

Conclusions: The authors conclude that there is limited evidence for haloperidol in preventing or treating delirium. Future studies must not aim to assess the resolution of delirium; instead, they must modify outcome measures, to mainly behavioral and psychiatric symptoms such as agitation, hallucinations, and persecutory delusions in delirium.