The FDA extended warning for intravenous haloperidol and torsades de pointes: How should institutions respond?

Summary: This study investigated the frequency and magnitude of QTc interval prolongation and clinically relevant side effects in delirium patients managed with haloperidol and/or pipamperone. The results showed that delirium treatment with antipsychotics did not increase the risk of QTc interval prolongation, but the prolongation magnitude was higher and correlated with dosage and the number of QT interval-prolonging substances. Polypharmacy was associated with increased risk of critical QTc prolongation and higher mortality during delirium.

Summary: The DASH-AF trial evaluates the safety and feasibility of initiating oral sotalol therapy in atrial fibrillation patients through rapid intravenous sotalol loading, achieving a steady state with maximum QTc prolongation within 6 hours instead of the traditional 5-dose oral titration. The study shows that rapid intravenous sotalol loading is feasible and safe, with a lower dose adjustment rate and potential cost savings.

Summary: Amiodarone should be avoided as a first-line therapy in patients without heart disease due to its potential to induce TdP. Careful monitoring of QT interval, particularly during intravenous administration, can help prevent the development of this life-threatening arrhythmia.