Pharm

Haloperidol

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Haloperidol, Haldol, Haloperidol Lactate, Haloperidol decanoate

  • Indications
  1. Psychosis
  2. Delirium
  3. Schizophrenia
  4. Tic Disorders (including Tourette's Syndrome)
  5. Acute Mania
  • Contraindications
  1. Pregnancy and Lactation
  2. Phencyclidine (PCP) Overdose
  3. Anticholinergic Syndromes
  4. Alcohol or Benzodiazepine Withdrawal
  5. Hepatic Insufficiency
  6. Neuroleptic Malignant Syndrome
  • Class
  1. First Generation Antipsychotic
  • Dosing
  • Haloperidol
  1. Dose
    1. Adult: 5-10 mg PO, IM, or IV
    2. Peds: 0.5-1 mg PO, IM or IV
    3. Adolescent: 1-5 mg PO, IM or IV
    4. Elderly: 0.5-2 mg PO, IM or IV
  2. Intervals: Scheduled and repeated dosing intervals
    1. May repeat every 30-60 minutes
    2. Maximum: 300 mg/24 hours (avoid cummulative dose over 100 mg in 24 hours)
    3. May dose regularly every 6-8 hours
      1. Typical effective dose: 5 mg PO, IV, or IM tid (lower doses in the elderly)
    4. Total dose >3 mg/day is associated with Extrapyramidal Side Effects
  • Dosing
  • Haloperidol decanoate (depot form)
  1. Haloperidol decanoate 100 mg IM every 4 weeks
  2. Cost effective (may be as low as $19 generic)
  • Precautions
  1. Intravenous doses have a much shorter duration of action than other routes
  2. Antipsychotics are associated with increased mortality in the elderly
  • Adverse effects
  1. Serious
    1. See Extrapyramidal Side Effects (EPSE)
    2. Neuroleptic Malignant Syndrome
    3. Hypotension
    4. Dystonia
    5. Seizures
    6. Prolonged QT interval
      1. Risk of Torsades de Pointes
      2. Dose related effect with higher risk at higher doses
  2. Common
    1. Insomnia
    2. Restlessness
    3. Anxiety
    4. Sedation
    5. Headache
    6. Weight gain
    7. Hyperprolactinemia
    8. Blood dyscrasia
  • Monitoring
  1. Serum Prolactin
    1. Obtain if indicated
  2. Complete Blood Count (indicated if history of Leukopenia)
    1. Baseline
    2. Monthly in first 3 months of therapy