Haloperidol markedly reduced pain and nausea in ED patients with gastroparesis compared to usual care. Plus, it led to fewer admissions. But be careful. Haloperidol is not without side effects, such as hypotension, extrapyramidal movement, akathisia, neuroleptic malignant syndrome, and QT-prolongation.
Why does this matter?
It is difficult to find any therapy that gives patients with gastroparesis relief. This has now been proven effective, which is saying something.
It works but at what cost?
Patients with gastroparesis are often miserable, and not much seems to make them feel better. This small double-blinded RCT with 33 ED patients who had gastroparesis compared usual care to haloperidol plus usual care. The haloperidol group had a drastic reduction in pain and nausea. This study shows that haloperidol works, but it had some limitations. It was a small trial. And haloperidol is fraught with side effects, as outlined above. Plus, tardive dyskinesia may occur after limited use of such neuroleptic agents and is more common in patients over age 55. So the patient may feel better but have uncontrollable mouth movements for the rest of his or her life. At least have an informed discussion with your patient before dropping the H-bomb on them.
Randomized Controlled Double-Blind Trial Comparing Haloperidol Combined with Conventional Therapy to Conventional Therapy Alone in Patients with Symptomatic Gastroparesis. Acad Emerg Med. 2017 Jun 24. doi: 10.1111/acem.13245. [Epub ahead of print]
Peer reviewed by Thomas Davis, MD.