haloperidol HALDOL

Class: First Generation Antipsychotic/​Butyrophenone
FDA Indications: Manifestations Of Psychotic Disorders, Severe Behavior Problems In Children With Combative, Explosive Hyperexcitabile Behaviors, Tourette's Disorder
Off-Label Use: OCD, Behavioral Disturbances With Dementia, Delirium (with lorazepam), 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%)
Known Risk of TdP
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: D1 (high), D2 (very high), 5HT2 (high), α1 (low), H1 (low), M1 (low)
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.


2019 BEE℞S Recommendation: Avoid, except in schizophrenia or bipolar disorder. Increased risk of CVA and greater rate of cognitive decline and mortality in persons with dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options have failed or are not possible and the older adult is threatening substantial harm to self or others.

No dosage adjustment necessary.


No dosage adjustment necessary.

logo

Developed & Designed by Kevin M. Nasky, D.O. • Built with Bootstrap, PHP & MySQL • Hosted by SiteGround
Last updated March 25 2019 15:25:58. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.