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Evidence summaries

Haloperidol for Agitation in Dementia

Haloperidol may have some efficacy in controlling aggression, but it does probably not improve other manifestations of agitated dementia. Haloperidol appears to have more extrapyramidal adverse effects than risperidone. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 5 studies. The overall results showed no improvement in agitation. There is some evidence that haloperidol helps to control aggression (Behave-AD scale, aggression subscore, WMD -0.92, 95% CI -1.75 to -0.09). Adverse reactions (mainly extrapyramidal symptoms) and dropouts were more frequent among haloperidol treated patients. Higher doses of haloperidol (more than 2 mg/day) may be more effective in controlling aggression, but they cause more adverse effects than lower doses.

A topic in Clinical Evidence 2 summarizes the results of one systematic review including 2 RCTs with a total of 402 patients, comparing haloperidol and risperidone. Similar proportions of patients had improvement in agitation. One of the RCTs (n=344) assessed adverse effects and found that haloperidol increased the frequency (22% vs 15%, p=0.023) and the severity of extrapyramidal symptoms (Extrapyramidal Symptoms Rating Scale score: mean +1.6 vs -0.3, p<0.05) compared to risperidone.

The authors conclude that haloperidol cannot be recommended for routine use in the control of agitated dementia.

Comment: The quality of evidence is downgraded by imprecise results (sparse data) and inconsistency (heterogeneity of patients, interventions and outcomes).

    References

    • Lonergan E, Luxenberg J, Colford J. Haloperidol for agitation in dementia. Cochrane Database Syst Rev 2002;(2):CD002852. [Last assessed as up-to-date: 11 September 2008][PubMed]
    • Warner J, Butler R, Arya P. What are the effects of treatments on behavioural and psychological symptoms in dementia? Clinical Evidence 2005;13:1227-1236.

Primary/Secondary Keywords