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First-generation dopamine antagonists, most commonly haloperidol, are essential tools for managing delirium and behavioral emergencies. However, they have been stigmatized and purported to directly cause adverse events, such as arrhythmia due to QT prolongation. To many clinicians who order haloperidol routinely, this representation is based on legacy fears rather than objective risk assessment.
In this meta-analysis of 84 randomized trials (with 12,000 patients) in which haloperidol was compared with placebo or active comparators, researchers analyzed the incidence of major adverse cardiac events (MACE): death, cardiac arrest, ventricular arrhythmia (including torsades de pointes), seizure, or syncope. Patients with known cardiac comorbidit…