Haloperidol
Mechanism :
Haloperidol is a butyrophenone derivative with antipsychotic properties that has been considered particularly effective in the management of hyperactivity, agitation, and mania. Haloperidol is an effective neuroleptic and has a marked tendency to provoke extrapyramidal effects. The mechanism of action of haloperidol has not been entirely elucidated but has been attributed to the inhibition of the transport mechanism of cerebral monoamines, particularly by blocking the impulse transmission in dopaminergic neurons.
Indication :
- Schizophrenia, psychosis/sedation
- Tourette syndrome
- Intractable hiccup
- Persistent nausea
- Behavioural disorders
- Acute agitation.
Contraindications :
Contraindicated in severe toxic central nervous system depression or comatose states from any cause and in individuals who are hypersensitive to this drug or have Parkinson disease. Do not use in patients with known hypersensitivity to phenothiazines.
Dosing :
Schizophrenia, mania and tic disorders, Tourette syndrome:
2-12 years:
25-50 microgram/day (Max: 10 mg/day) and divided into two or three doses.
12-18 years:
0.5-2 mg/day (Max: 60 mg/day) in divided between 2 doses.
Intractable hiccup:
12-18 years-1.5 mg TDS.
Adverse Effect :
Akathisia, Parkinson-like symptoms, dystonia or muscle stiffness, Tardive Dyskinesia, insomnia, anxiety, euphoria, restlessness, agitation, grand mal seizures, drowsiness, depression, lethargy, vertigo, headache, confusion, exacerbation of psychotic symptoms including hallucinations, hyperpyrexia, hyperthermia, neuroleptic malignant syndrome (NMS), weight gain, tachycardia, alteration in the blood pressure, QT prolongation, mild and usually transient leukopenia and leucocytosis, minimal decreases in red blood cell counts, anemia, or a tendency toward lymphomonocytosis, increased liver enzymes or jaundice, maculopapular and acneiform skin reactions, lactation, mastalgia, breast engorgement, oligomenorrhea or dysmenorrhea, impotence, gynecomastia, hyperglycemia, increased libido, anorexia, nausea and vomiting, alteration of bowel habits, hypersalivation, dyspepsia, dry mouth, diaphoresis, blurred vision, priapism, urinary retention, laryngospasm, bronchospasm and hyperpnoea.
Interaction :
Contraindicated:
Cisapride, Dronedarone, Mifepristone, Pimozide, Potassium Acid Phosphate, Potassium Chloride, Potassium Citrate, Potassium Phosphate, Quinidine (CYP2D6 booster), Thioridazine, Toremifene.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Start with lower doses. For single doses use 100% of normal dose. Accumulation with repeated dosage |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Not dialysed. Dose as in GFR<10 mL/min |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
Haloperidol is extensively metabolized in the liver. it is recommended to halve the initial dose and adjust the dose with smaller increments and at longer intervals than in patients without hepatic impairment.