Haldol


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Haldol

 [hal´dol]
trademark for a preparation of haloperidol, an antipsychotic agent.

haloperidol lactate

Haldol

Pharmacologic class: Butyrophenone

Therapeutic class: Antipsychotic

Pregnancy risk category C

FDA Box Warning

• Drug increased mortality in elderly patients with dementia-related psychosis. Although causes of death were varied, most appeared to be cardiovascular or infectious. Drug isn't approved for treatment of dementia-related psychosis.

Action

Unknown. Thought to block postsynaptic dopamine receptors in brain and increase dopamine turnover rate, inhibiting signs and symptoms of psychosis.

Availability

Injection (decanoate): 50 mg/ml, 100 mg/ml

Injection (lactate): 5 mg/ml

Oral concentrate (lactate): 2 mg/ml

Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg

Indications and dosages

Symptomatic treatment of psychotic disorders or Tourette syndrome

Adults: For moderate symptoms, 0.5 to 2 mg P.O. two to three times daily. For severe symptoms or chronic or resistant disorder, 3 to 5 mg P.O. two to three times daily, to a maximum of 100 mg daily if needed. Adjust subsequent dosages carefully based on response and tolerance. Alternatively, 2 to 5 mg I.M. (lactate) may be given for prompt control of acutely agitated patient with moderate to severe symptoms; based on response, subsequent doses may be given q hour.

Schizophrenia in patients who need prolonged parenteral antipsychotic therapy

Adults: For patient previously stabilized on oral haloperidol, initial I.M. dose (decanoate) is 10 to 20 times the previous daily P.O. haloperidol equivalent, depending on patient's stability on low or high P.O. dosage. Initially, I.M. dosage shouldn't exceed 100 mg. If conversion requires dosage above 100 mg, give balance in 3 to 7 days. Maintenance dosage is 10 to 15 times the previous daily P.O. dosage, depending on response.

Psychotic disorders

Children ages 3 to 12 or weighing 15 to 40 kg (33 to 88 lb): 0.05 to 0.15 mg/kg/day P.O. in two or three divided doses. May be increased by 0.5 mg daily given in two or three divided doses at 5- to 7-day intervals, depending on response and tolerance.

Nonpsychotic behavior disorder; Tourette syndrome; hyperactivity

Children ages 3 to 12 or weighing 15 to 40 kg (33 to 88 lb): 0.05 to 0.075 mg/kg/day P.O. in two or three divided doses

Dosage adjustment

• Elderly or debilitated patients

Off-label uses

• Nausea and vomiting
• Infantile autism
• Intractable hiccups

Contraindications

• Hypersensitivity to drug, tartrazine, sesame oil, or benzyl alcohol (with some products)
• Severe CNS depression or comatose states
• Parkinson's disease

Precautions

Use cautiously in:
• torsades de pointes, QT interval prolongation
• patients with allergies
• hepatic disease, bone marrow depression, cardiac disease, respiratory insufficiency, CNS tumors
• history of seizures, patients receiving anticonvulsants, EEG abnormalities
• concurrent anticoagulant use
• elderly patients
• pregnant or breastfeeding patients
• children (parenteral form not recommended).

Administration

• Be aware that torsades de pointes and QT interval prolongation have occurred in patients receiving haloperidol, especially when drug is given I.V. or in doses higher than recommended. Haloperidol isn't approved for I.V. use.

Don't give decanoate form I.V.
• Administer decanoate form by deep I.M. injection using 21G needle. Two injections may be necessary; maximum volume shouldn't exceed 3 ml.
• Know that recommended interval between I.M. injections is 4 weeks.
• Dilute oral concentrate in water, soda, or juice (orange, apple, tomato) immediately before administering.
• Be aware that patient should be switched from parenteral form to oral form as soon as possible.
• Know that parenteral form is not recommended in children.

Adverse reactions

CNS: confusion, drowsiness, restlessness, extrapyramidal reactions, sedation, lethargy, insomnia, vertigo, tardive dyskinesia, seizures, neuroleptic malignant syndrome

CV: hypotension, hypertension, tachycardia, ECG changes, torsades de pointes (with I.V. use)

EENT: blurred vision, dry eyes

GI: constipation, ileus, dry mouth, anorexia

GU: urinary retention, menstrual irregularities, gynecomastia, priapism

Hematologic: anemia, leukocytosis, leukopenia

Hepatic: jaundice, drug-induced hepatitis

Metabolic: galactorrhea

Respiratory: dyspnea, respiratory depression, bronchospasm, laryngospasm

Skin: diaphoresis, photosensitivity, rash

Other: hyperpyrexia, hypersensitivity reactions

Interactions

Drug-drug.Antidepressants, antihistamines, atropine, disopyramide, phenothiazines, quinidine, other anticholinergics: additive anticholinergic effects

Antihypertensives, nitrates: additive hypotension

CNS depressants (including antihistamines, opioid analgesics, sedative-hypnotics): additive CNS depression

Epinephrine: severe hypotension and tachycardia

Levodopa, pergolide: decreased therapeutic effects of haloperidol

Lithium: acute encephalopathic syndrome

Methyldopa: dementia

Rifampin: decreased haloperidol plasma level

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, thyroid function tests: increased values

Arterial blood gases, bicarbonate: altered values

White blood cells: increased or decreased count

Drug-herbs.Angel's trumpet, jimsonweed, scopolia: antagonism of cholinergic effects

Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Nutmeg: reduced haloperidol efficacy

Drug-behaviors.Acute alcohol ingestion: additive hypotension

Patient monitoring

Monitor CNS status closely, especially for seizures and neuroleptic malignant syndrome (shown by extrapyramidal symptoms, hyperthermia, and autonomic disturbances).

Monitor cardiovascular status, particularly for ECG changes, blood pressure changes, torsades de pointes, and atypical rapid ventricular tachycardia, which may progress to ventricular fibrillation (with I.V. use).
• Assess respiratory status.
• Monitor liver function test results and CBC with white cell differential.
• With prolonged use, assess for tardive dyskinesia (which may occur months or even years after starting drug).

Patient teaching

• Tell patient to dilute oral concentrate with water, cola, or juice immediately before taking.

Instruct patient to immediately report signs or symptoms of serious adverse reactions, such as unusual weakness, yellowing of skin or eyes, difficulty breathing, or symptoms of neuroleptic malignant syndrome (such as fever, muscle pain or rigidity, rapid or irregular pulse, increased sweating, change in urination pattern, or decreased mental acuity).
• Advise patient to minimize GI upset by eating frequent, small servings of food and drinking adequate fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

Haldol

(hăl′dôl′, -dŏl′, -dōl′)
A trademark for the drug haloperidol.

Haldol

a trademark for a tranquilizer (haloperidol).

Haldol®

Haloperidol, see there.

Haldol

A brand name for HALOPERIDOL.

Haldol

A brand name for HALOPERIDOL.
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The court held that the administration of medication would not significantly further the state's interests, that alternatives existed to involuntary administration of the drug Haldol, and that involuntary administration of Haldol was not in the defendant's best medical interest.
There is little improvement academically, almost no speech, and physicians continue to alter Ben's unacceptable behavior with the use of medications such as Clonidine and Haldol.
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The use of stimulants was in the medical tradition of the use of the then-new antipsychotic drugs Thorazine and Haldol, which did not cure schizophrenia but did reduce the violent and hideously self-mutilating behaviors of some patients, allowing them to live in the general populations of the institutions for the chronically ill without fear of violence to others or serious damage to themselves.
The evidence showed, inter alia, that after the patient in question was returned to the facility, he was restrained with a "posey restraint," a "geri tray," and wrist restraints, and was medicated with Haldol.
The newer drugs entered the market in the mid-1990s at a time of concern about the neurological disorders caused by older medications such as Haldol and Thorazine, which made many users doze, drool and twitch.
With these patients, drugs on Class 1, 2 and 4 should also be avoided) amiodarone, biaxin chloral hydrate, cocaine as local chloroquine, indapamide, lithium, anaesthetic, dexatrine, chlorpromazine serevent, ventolin, dobutamine, dopamine, cisaprid, zithromax ephedrine, epinephrine, clarithromycin, levophed, appetite disopyramide, suppressant phentermine, domperidone, haldol, dexatrim[R], acutrim[R], mellaril, methadone, sibutramine, ritilin, procainamide, ventolin sotalol Class 1: Drugs that Class 4: Drugs that are weakly are accepted by associated with TdPand/or QT authorities to have prolongation but are unlikely to be a risk of prolonging a risk for TdP when used in usual QT interval and TdP recommended dosages and in patients without other risk factors *.
The complaint in the wrongful death lawsuit filed by Harris's estate against the nursing home and an adjunct hospital alleges that the drugs administered shortly after his arrival--Risperdal, a so-called atypical antipsychotic, and Haldol, an older antipsychotic--caused Harris to become "an involuntary catatonic prisoner.
Revised labeling on the drug, marketed as Haldol, Haldol decanoate, and Haldol lactate, includes a cardiovascular subsection explaining the increased risk for prolonging the QT interval.
Friends and relatives say that he, while being weaned off pain medication, was administered -- wrongly, they contend -- the powerful anti-psychotic drug Haldol.
Neuroleptic drugs go by trade names such as Thorazine, Haldol, Seroquel, Zyprexa, Risperdal, and many others.