Names and pronunciation
(hal-oh-pehr′ih-dol) Haldol Decanoate, Haldol
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Individual generic drug information
Extracted information for haloperidol only.
(hal-oh-pehr′ih-dol) Haldol Decanoate, Haldol
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Func. class.: Antipsychotic, neuroleptic
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Chem. class.: Butyrophenone
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ACTION: Blocks neurotransmission produced by DOPamine at synapse; exhibits strong α-adrenergic, anticholin- ergic blocking action; mechanism for antipsychotic effects unclear
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USES: Tourette’s syndrome, pro- longed parenteral therapy in chronic schizophrenia, emergency sedation of severely agitated or delirious patients, ADHD, oppositional defiant disorder
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Unlabeled uses: Autistic disorder, delir- ium, mania, hiccups, chemotherapy- induced nausea/vomiting
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Extracted information for haloperidol only.
CONTRAINDICATIONS: Hyper- sensitivity, coma, Parkinson’s disease Precautions: Pregnancy, breastfeeding, geriatric patients, seizure disorders, hypertension, pulmonary/cardiac/hepatic disease, QT prolongation, torsades de pointes, prostatic hypertrophy, hyperthy- roidism, thyrotoxicosis, children, blood dyscrasias, brain damage, bone marrow depression, alcohol and barbiturate with- drawal states, angina, epilepsy, urinary retention, closed-angle glaucoma, CNS depression
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Black Box Warning: Increased mortality in elderly patients with dementia-related psychosis Black Box Warning: Increase: respira- tory depression, death opioids Black Box Warning: Increase: overseda- tion—opioids, other CNS depressants, alcohol, barbiturate anesthetics Increase: toxicity—EPINEPHrine, lithium Increase: anticholinergic effects—anti- cholinergics Drug/Lab Test Increase: LFTs Black Box Warning: Assess for dementia, affect, orientation, LOC, reflexes, gait, co- ordination, sleep pattern disturbances, risk for death in dementia-related psychosis • CV: B/P standing, lying; take pulse, respirations during initial treatment; es- tablish baseline before starting treat- ment; report drops of 20 mm Hg • Dizziness, faintness, palpitations, tachy- cardia on rising • Fall risk assessment: Assess for fall potential baseline and during treatment; supervised ambulation until patient stabi- lized on medication; do not involve pa- tient in strenuous exercise program, fainting is possible; patient should not stand still for long periods • Extrapyramidal symptoms, including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremi- ties), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait) after long-term use • Neuroleptic malignant syndrome/ serotonin syndrome: hyperthermia, muscle rigidity, altered mental status, in- creased CPK, seizures, hypo/hypertension, tachycardia; notify prescriber immediately • Constipation, urinary retention daily; if these occur, increase bulk, water in diet • Abrupt discontinuation: do not with- draw abruptly, taper • QT prolongation: more common with IV use at high doses; monitor ECG in those with CV disease • Esophageal aspiration risk: Assess for aspiration risk in pneumonia, dementia Black Box Warning Beers: avoid use in older adults except for schizophrenia, bipolar disorder; increased risk of stroke and cognitive decline, mortality • Pregnancy/breastfeeding: no well- controlled studies; use in 3rd trimester results in infant extrapyramidal symp- toms; avoid breastfeeding Black Box Warning: Opioids: Discuss with patient, family, caregivers to report immedi- ately, dizziness, severe drowsiness, slowed breathing, to obtain emergency services • To report impaired vision, jaundice, tremors, muscle twitching • To use sunscreen, protective clothing to minimize photosensitivity, avoid overheating • To take as prescribed; not to use OTC, herbal products or alcohol unless di- rected by prescriber • To use good oral hygiene, frequent sips of water, sugarless gum, candy for dry mouth
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SIDE EFFECTS CNS: EPS: pseudoparkinsonism, akathi- sia, dystonia, tardive dyskinesia; drows- iness, headache, seizures, neuroleptic malignant syndrome, confusion CV: Orthostatic hypotension, ECG changes, tachycardia, QT prolongation, torsades de pointes EENT: Blurred vision, glaucoma, dry eyes GI: Dry mouth, nausea, vomiting, anorexia, constipation, weight gain, ileus, hepatitis HEMA: Agranulocytosis, anemia, neutro- penia, leukopenia GU: Urinary retention, urinary frequency, impotence INTEG: Rash, photosensitivity, dermatitis RESP: Respiratory depression SYST: Risk for death (dementia)
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INTERACTIONS Increase: serotonin syndrome, neurolep- tic malignant syndrome—SSRIs, SNRIs Increase: QT prolongation—class IA, III antidysrhythmics, tricyclics, amoxapine, maprotiline, phenothiazines, pimozide, risperiDONE, sertindole, ziprasidone, β-blockers, chloroquine, cloZAPine, dasatinib, dolasetron, droperidol, droned- arone, flecainide, halogenated/local anes- thetics, lapatinib, methadone, erythro mycin, telithromycin, troleandomycin, octreotide, ondansetron, palonosetron, pentamidine, propafenone, ranolazine, SUNItinib, tacrolimus, vardenafil, vorino- stat, usually with IV use
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TREATMENT OF OVERDOSE: Lavage if recently ingested orally; provide an airway; do not induce vomiting; pro- vide supportive care HIGH ALERT
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Extracted information for haloperidol only.
DOSAGE AND ROUTES Schizophrenia • Adult: PO 0.5-2 mg bid-tid depending on severity Severe symptoms: 3-5 mg orally 2-3 times a day; haloperidol lactate IM 2-5 mg q4-8hr, max 20 mg/day; Haloperidol decanoate IM Max initial dose 100 mg; if greater than 100 mg is needed, the dose should be given in 2 separate injections (100 mg followed by the balance in 3-7 days). Maintenance 10-15 times the pre- vious daily PO dose, given IM monthly, ti- trate to response; max 450 mg/mo
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Available forms: Tabs 0.5, 1, 2, 5, 10, 20 mg; lactate: oral sol 2 mg/mL; inj 5 mg/mL, decanoate: 50 mg/mL, 100 mg/mL
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Administer: H • Reduced dose to geriatric patients • Antiparkinsonian agent if EPS occurs • Avoid use with CNS depressants PO route • Store in tight, light-resistant container • Oral liquid: use calibrated device; do not mix in coffee or tea • PO with food or milk • Avoid skin contact with oral suspen- sion or solution—may cause contact dermatitis IM route (long acting) • IM inj into large muscle mass, use 21-G, 2-in needle, use Z track method; give no more than 3 mL/inj site; patient should remain recumbent for 30 min, protect from light
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Extracted information for haloperidol only.
Assess: • Mental status: Monitor mood, behav- ior, orientation, affect, LOC, sleep pat- terns, presence of delusions, hallucina- tions; baseline, periodically • Monitor prolactin, CBC, urinalysis, oph- thalmic exam before and during prolonged therapy
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Evaluate: • Therapeutic response: decrease in emotional excitement, hallucinations, de- lusions, paranoia; reorganization of patterns of thought, speech; improvement in spe- cific behaviors
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That orthostatic hypotension occurs often; to rise from sitting or lying position gradually; to remain lying down after IM inj for at least 30 min • To avoid hazardous activities until stabi- lized on medication and effects are known • To avoid abrupt withdrawal of this prod- uct because EPS may result; to withdraw slowly • To avoid OTC preparations (cough, hay fever, cold) unless approved by pre- scriber; serious product interactions may occur; to avoid use with alcohol, as in- creased drowsiness may occur • About EPS and the necessity of meticu- lous oral hygiene because oral candidiasis may occur
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Extracted information for haloperidol only.
PHARMACOKINETICS Metabolized by liver; excreted in urine, bile; crosses placenta; enters breast milk; protein binding 92%; half-life 12-36 hr (metabolites) PO: Onset erratic, peak 2-6 hr, half-life 14-37 hr IM (Lactate): Onset 15-30 min, peak 15-20 min, half-life 21 hr IM (Decanoate): Peak 4-11 days, half- life 3 wk
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Filter the extracted dose blocks for this individual drug.
Schizophrenia
• Adult: PO 0.5-2 mg bid-tid depending on severity Severe symptoms: 3-5 mg orally 2-3 times a day; haloperidol lactate IM 2-5 mg q4-8hr, max 20 mg/day; Haloperidol decanoate IM Max initial dose 100 mg; if greater than 100 mg is needed, the dose should be given in 2 separate injections (100 mg followed by the balance in 3-7 days). Maintenance 10-15 times the pre- vious daily PO dose, given IM monthly, ti- trate to response; max 450 mg/mo
Candidate age grouping · source page 641