What is the maintenance dosing after loading for haloperidol in delirium?

What is the maintenance dosing after loading for haloperidol in delirium?

• A. 100% of loading dose every 12 hours
• B. 25% of loading dose every 6 hours
• C. 50% of loading dose every 24 hours
• D. No maintenance dose; stop after loading

Answer: (B)

After giving a loading dose to rapidly reach therapeutic levels, the goal is to keep those levels stable with smaller, regular maintenance dosing. The best approach is to administer a quarter of the loading dose every six hours. This keeps plasma concentrations within the desired range, maintaining relief of agitation and delirium symptoms while minimizing peaks that could raise the risk of oversedation or extrapyramidal side effects. For example, if the loading dose was 2 mg, the maintenance dose would be 0.5 mg every six hours. Dosing like this avoids large surges in drug level and avoids letting the level drop too low between doses, which could allow symptoms to recur or worsen. Other schemes that pile a large amount in one dose or spread too sparsely over time tend to cause undesirable peaks or troughs and are less effective at sustaining control of delirium symptoms. Not giving any ongoing maintenance would fail to maintain therapeutic levels and symptoms would likely return.

After giving a loading dose to rapidly reach therapeutic levels, the goal is to keep those levels stable with smaller, regular maintenance dosing. The best approach is to administer a quarter of the loading dose every six hours. This keeps plasma concentrations within the desired range, maintaining relief of agitation and delirium symptoms while minimizing peaks that could raise the risk of oversedation or extrapyramidal side effects.

For example, if the loading dose was 2 mg, the maintenance dose would be 0.5 mg every six hours. Dosing like this avoids large surges in drug level and avoids letting the level drop too low between doses, which could allow symptoms to recur or worsen.

Other schemes that pile a large amount in one dose or spread too sparsely over time tend to cause undesirable peaks or troughs and are less effective at sustaining control of delirium symptoms. Not giving any ongoing maintenance would fail to maintain therapeutic levels and symptoms would likely return.