haloperidol HALDOL

Class: First Generation Antipsychotic/​Butyrophenone
FDA Indications: Manifestations Of Psychotic Disorders, Tourette's Disorder, Severe Behavior Problems In Children With Combative, Explosive Hyperexcitabile Behaviors
Off-Label Use: Behavioral Disturbances With Dementia, Delirium (with lorazepam), OCD, Chemotherapy-induced Nausea/vomiting, Nausea/vomiting In Terminal Illness, PCP-induced Psychosis, Rapid Tranquilization, Prevention Of PONV
Prescribing
Forms: 0.5, 1, 2, 5, 10, 20mg tablet; 1mg/mL po soln; 5mg/mL IM; LAI: 50 mg/mL, 100 mg/mL
Dose Range: 1-40 mg/day
Starting: PO: Start 0.5-2 mg bid to or tid; usual max 40mg/day; LAI: initially 10-15x oral dose, given Q month
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis
Monitoring:

NAMI drug fact sheet

Precautions
Contraindications: Parkinson's disease
Serious Side Effects: , , , Cardiac Arrhythmias, Neutropenia and/or Agranulocytosis (rare), Hyperprolactinemia (♀ 60%; ♂ 40%)
Side Effects: sedation/somnolence, dizziness, weight gain, akathisia, orthostatic hypotension, EPS, Neuroleptic-Induced Deficit Syndrome, decreased sweating
Pharmacodynamics
1° MOA: Dopamine 2 (D2) receptor antagonism in mesolimbic area
Target: D2 blockade, α1
Pharmacokinetics
t½: 24 (12-36)° TMAX: 2-6°
Substrate of: 3A4; 1A2, 2D6
Inhibits: 2D6 (major), 3A4 (minor); Induces:
Active Metabolites: RHAL
DDIs
Misc
  • - classic high potency typical antipsychotic
  • - no significant antihistaminic or antimuscarinic actions
  • - lack of anticholinergic activity could, in such a potent dopamine antagonist, account for its poor EPS tolerability
  • - anticholinergics should probably automatically co-prescribed (versus PRN)
  • - Tmax of IM haloperidol takes place after 20 min (faster than PO administration)
  • - APA practice guidelines on the use of antipsychotics to treat agitation & psychosis in patients with dementia recommends against use of haloperidol as a first-line treatment for pts w/ dementia w/o evidence of delirium in nonemergency situations
Special Populations

Category C—Associated with limb malformations in first trimester use. Third-trimester use can result in EPS or withdrawal symptoms in the newborn

RID 0.2-12%


Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.

No dosage adjustment necessary.


No dosage adjustment necessary.

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Last updated January 22 2018 19:18:05. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.