Forms: 2, 5mg tablet; 2mg/5mL IM Dose Range: 5-15 mg/day Starting: EPS: 5-15 mg/day; assess effect and increase dose empirically as tolerated
Parkinsonism: start at 1 mg qd; after 3 days can increase in 2 mg increments q 3-5 days as tolerated until clinical effect is reached; total daily dose should be given t.i.d. a.c. Stopping: Do not abruptly discontinue.
Neuroleptic Malignant Syndrome (NMS)
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status (including catatonic signs) and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure.
The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology.
The management of NMS should include 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.
If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported.
Hyperpyrexia and heat stroke, not associated with the above symptom complex, have also been reported with haloperidol.
has been reported in association with dose reduction or discontinuation of trexyphenidyl
1° MOA: Centrally-acting antimuscarinic agent; reinstates balance of dopaminergic to cholinergic activity in the nigrostriatal pathway (as dopaminergic activity ↓ d/t D2-blockade, the anti-ACh aims to likewise ↓ cholineric activity and restore the DA/ACh ratio) Target: M1
- caution with co-prescribed CNS depressants which can ↑ sedative effects
can enhance anticholinergic actions of other anticholinergic agents
- may be more abusable than other anticholinergic medications, presumably due to its dopamine-enhancing actions
sedation limits use, especially in older patients
useful adjunct in younger Parkinson's patients with tremor
can cause cognitive side effects with chronic use, so periodic trials of discontinuation may be useful to justify continuous use, especially in institutional settings as adjunct to antipsychotics
Category C—The limited human pregnancy experience and the absence of animal reproduction data prevents a better assessment of the embryo-fetal risk. However, in general, anticholinergics are considered low risk in pregnancy.
Limited Human Data—Probably Compatible
Use with caution; elderly patients may be more susceptible to side effects
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Last updated August 27 2018 18:45:06. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
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