What is the role of dopamine antagonists in the treatment of delirium tremens (DTs)?

Updated: Nov 06, 2020
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

As the extreme hyperglutamatergic and hyperdopaminergic states that occur in severe alcohol withdrawal are thought to be responsible for paranoia, hallucinations, and agitated delirium, there may be a role for small titrated doses of dopamine antagonists (eg, haloperidol) in highly agitated patients, provided that adequate treatment with GABA coverage (benzodiazepines, phenobarbital) has been administered. Some authorities recommend haloperidol at a dose of 0.5-5 mg intravenously or intramuscularly every 30-60 minutes or the same dose orally every 4 hours for severe agitation, perceptual disturbances, or disturbed thinking not adequately controlled by high-dose benzodiazepines.


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