Haloperidol (tablet): Difference between revisions

Jump to navigation Jump to search
m (Robot: Automated text replacement (-{{SIB}} + & -{{EH}} + & -{{EJ}} + & -{{Editor Help}} + & -{{Editor Join}} +))
No edit summary
Line 1: Line 1:
{{Drugbox|
{{DrugProjectFormSinglePage
|IUPAC_name = 4-[4-(4-chlorophenyl)-4-hydroxy-1-piperidyl]-<BR>1-(4-fluorophenyl)-butan-1-one
|authorTag=<!--Overview-->
| image = Haloperidol.svg
|aOrAn=a
| image2 = Haloperidol-3D-vdW.png
|hasBlackBoxWarning=Yes
| width = 250px
|adverseReactions=<!--Black Box Warning-->
| CAS_number = 52-86-8
|blackBoxWarningTitle=<span style="color:#FF0000;">ConditionName: </span>
| ATC_prefix = N05
|blackBoxWarningBody=<i><span style="color:#FF0000;">ConditionName: </span></i>
| ATC_suffix = AD01
 
| PubChem = 3559
* Content
| DrugBank = APRD00538
 
| C=21|H=23|Cl=1|F=1|N=1|O=2
<!--Adult Indications and Dosage-->
| molecular_weight = 375.9 g/mol (plain haloperidol)
 
| bioavailability = Approx. 60 to 70% (tablets and liquid)
<!--FDA-Labeled Indications and Dosage (Adult)-->
| metabolism = hepatic
|fdaLIADAdult======Condition1=====
| elimination_half-life = 12 to 36 hours
 
| excretion = Biliary and [[kidney|renal]]
* Dosing Information
| pregnancy_category = C
 
| legal_status = Rx-only
:* Dosage
| routes_of_administration = Oral, [[Intramuscular injection|IM]], [[Intravenous therapy|IV]], [[Injection (medicine)#Depot injection|depot]] (as [[decanoate]] [[ester]])
 
}}
=====Condition2=====
{{SI}}
 
{{CMG}}
* Dosing Information
 
:* Dosage
 
=====Condition3=====
 
* Dosing Information
 
:* Dosage
 
=====Condition4=====
 
* Dosing Information
 
:* Dosage
 
<!--Off-Label Use and Dosage (Adult)-->
 
<!--Guideline-Supported Use (Adult)-->
|offLabelAdultGuideSupport======Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
 
<!--Non–Guideline-Supported Use (Adult)-->
|offLabelAdultNoGuideSupport======Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
 
<!--Pediatric Indications and Dosage-->
 
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Off-Label Use and Dosage (Pediatric)-->
 
<!--Guideline-Supported Use (Pediatric)-->
|offLabelPedGuideSupport======Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport======Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Contraindications-->
|contraindications=* Condition1
 
<!--Warnings-->
|warnings=* Description
 
====Precautions====
 
* Description
 
<!--Adverse Reactions-->
 
<!--Clinical Trials Experience-->
|clinicalTrials=There is limited information regarding <i>Clinical Trial Experience</i> of {{PAGENAME}} in the drug label.
 
=====Body as a Whole=====
 
 
 
 
=====Cardiovascular=====
 
 
 
 
=====Digestive=====
 
 
 
 
=====Endocrine=====
 
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
 
=====Metabolic and Nutritional=====
 
 
 
 
=====Musculoskeletal=====
 
 
 
 
=====Neurologic=====
 
 
 
 
=====Respiratory=====
 
 
 
 
=====Skin and Hypersensitivy Reactions=====
 
 
 
 
=====Special Senses=====
 
 
 
 
=====Urogenital=====
 
 
 
 
=====Miscellaneous=====
 
 
 
<!--Postmarketing Experience-->
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
 
=====Body as a Whole=====
 
 
 
=====Cardiovascular=====
 
 
 
=====Digestive=====
 
 
 
=====Endocrine=====
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
=====Metabolic and Nutritional=====
 
 
 
=====Musculoskeletal=====
 
 
 
=====Neurologic=====
 


==Overview==
'''Haloperidol''' (sold under the tradenames '''Aloperidin''', '''Bioperidolo''', '''Brotopon''', '''Dozic''', '''Duraperidol''' (Germany), '''Einalon S''', '''Eukystol''', '''Haldol''', '''Halosten''', '''Keselan''', '''Linton''', '''Peluces''', '''Serenace''', '''Serenase''', '''Sigaperidol''') is a conventional, or [[typical antipsychotic|typical]], [[butyrophenone]]  [[antipsychotic]] [[medication|drug]] with pharmacological effects similar to the [[phenothiazines]].


It is used in the treatment of [[schizophrenia]] and, more acutely, in the treatment of acute [[psychosis|psychotic]] states and [[delirium]]. A long-acting decanoate ester is used as a long acting injection given two or three times weekly to people with [[schizophrenia]] who have a poor compliance with medication and suffer frequent relapses of illness. In some countries this can be involuntary under Community Treatment Orders.
=====Respiratory=====


It was developed in 1957 by the Belgian company [[Janssen Pharmaceutica]] and submitted to first clinical trials in [[Belgium]] in the same year. After being rejected by [[United States|U.S.]] company [[G. D. Searle & Company|Searle]] due to side effects, it was later marketed in the U.S. by [[McNeil Laboratories]]. It was approved by the [[FDA]], in 1988.


==Chemical structure==
Haloperidol is an odorless white to yellow crystalline powder. It contains two chemical [[benzene]] rings with a [[piperidine]] molecule bonded in between. One benzene ring is bonded with the element [[chlorine]] and the other benzene ring is bonded with the element [[fluorine]].


==Pharmacology==
=====Skin and Hypersensitivy Reactions=====
Haloperidol is a [[neuroleptic]] and a [[butyrophenone]].  Due to its strong central antidopaminergic action, it is classified as a highly potent neuroleptic.  It is approximately 50 times more potent than [[chlorpromazine]] on a weight basis (50mg chlorpromazine are equivalent to 1mg haloperidol).  Haloperidol possesses a strong activity against [[delusions]] and [[hallucinations]], most likely due to an effective [[dopamine]]rgic receptor blockage in the [[mesocortex]] and the [[limbic system]] of the brain.  It blocks the [[dopamine]]rgic action in the [[nigrostriatal pathway]]s, which is the probable reason for the high frequency of [[Extrapyramidal system|extrapyramidal]]-motoric side-effects ([[dystonia]]s, [[akathisia]], [[Parkinson's disease|pseudoparkinsonism]]).  It has minor [[histamine|antihistaminic]] and [[anticholinergic]] properties, therefore [[cardiovascular]] and anticholinergic side-effects such as [[hypotension]], [[dry mouth]], [[constipation]], etc., are seen quite infrequently, compared with less potent neuroleptics such as chlorpromazine.  Haloperidol also has [[sedative]] properties and displays a strong action against [[psychomotor]] agitation but due to a specific action in the [[limbic system]]. It therefore is an effective treatment for [[mania]] and states of agitation. Additionally, it can be given as an [[adjuvant]] in the therapy of severe chronic pain.{{Fact|date=June 2007}}


The peripheral antidopaminergic effects of haloperidol account for its strong antiemetic activity.  There, it acts at the [[chemoreceptor trigger zone]] (CTZ). Haloperidol is useful to treat severe forms of nausea/emesis such as those resulting from [[chemotherapy]]. The peripheral effects lead also to a relaxation of the gastric [[sphincter]] muscle and an increased release of the hormone [[prolactin]], with the possible emergence of breast enlargement and secretion of milk ([[lactation]]) in both sexes.


==Pharmacokinetics==
===Intramuscular injections===
The drug is well and rapidly absorbed and has a high bioavailability. Plasma-levels reach their maximum within 20 minutes after injection.  The decanoate injectable formulation is for intramuscular administration only and should never be used intraveneously.


===Intravenous injections===
=====Special Senses=====
The bioavailability is 100% and the very rapid onset of action is seen within about ten minutes.  The duration of action is 3 to 6 hours.  If haloperidol is given as slow IV infusion, the onset of action is retarded, but the duration prolonged compared to IV injection.


===Therapeutic concentrations===
Plasma levels of 4 micrograms per liter to 20 (up to 25) micrograms per liter are required for therapeutic action.  The determination of plasma levels can be used to calculate dose adjustments and to check compliance, particularly in long-term patients.  Plasma levels in excess of the therapeutic range may lead to a higher incidence of side-effects or even pose the risk of haloperidol intoxication.


==Uses==
A comprehensive review of haloperidol has found it to be an effective agent in treatment of symptoms associated with [[schizophrenia]].<ref name ="Joy07">{{cite journal | author = Joy CB, Adams CE, Lawrie SM | title = Haloperidol versus placebo for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 2 | pages = | publisher = John Wiley and Sons, Ltd. | date = 2006 | url = http://www.cochrane.org/reviews/en/ab003082.html (abstract) | doi = 10.1002/14651858.CD003082.pub2| id = ISSN 1464-780X}}</ref>


Haloperidol is also used in the control of the symptoms of:
=====Urogenital=====


* Acute [[psychosis]], such as drug psychosis (LSD, amphetamines, PCP), psychosis associated with high fever or metabolic disease
* Acute [[mania|manic phases]] until the concomitantly given first-line drugs such as lithium or valproate are effective
* [[Hyperactivity]], [[aggression]].
* Acute [[delirium]]
* Otherwise uncontrollable severe behavioral disorders in children and adolescents
* Agitation and confusion associated with cerebral [[sclerosis]]
* Adjunctive treatment of alcohol and opioid withdrawal
* Treatment of neurological disorders such as tics, [[Tourette syndrome]], and [[chorea]]
* Treatment of severe nausea/emesis (postoperative, side-effects of radiation and cancer chemotherapy)
* Adjunctive treatment of severe chronic pain, always together with [[analgesic]]s
* Therapeutic trial in personality disorders such as borderline personality disorders
* Also used in the treatment of Intractable hiccups


Some weeks or even months of treatment may be needed before a remission of schizophrenia is evident.


In some clinics the use of [[Atypical antipsychotic|atypical neuroleptics]] (e.g. [[clozapine]], [[risperidone]], [[olanzapine]], [[ziprasidone]]) is generally preferred over haloperidol, because these drugs have an appreciably lower incidence of extrapyramidal side-effects.  Each of these drugs, however, has its own spectrum of potentially serious side-effects (e.g. agranulocytosis with clozapine, weight gain with increased risk of diabetes and of stroke).  Atypical neuroleptics are also much more expensive and have recently been the subject of increasing controversy regarding their efficacy in comparison to older products and side effects.
=====Miscellaneous=====


Haloperidol is considered indispensable for treating psychiatric emergency situations.  It is enrolled in the [[World Health Organization]] [[List of Essential Medicines]].


As is common with typical neuroleptics, haloperidol is by far more active against "positive" psychotic symptoms (delusions, hallucinations etc.) than against "negative" symptoms (social withdrawal, autism etc.). The effectiveness of haloperidol against positive symptoms has not been outperformed by newer antipsychotics.


==Contraindications==
<!--Drug Interactions-->
===Absolute===
|drugInteractions=* Drug
* Preexisting [[coma]]
:* Description
* Severe intoxication with alcohol or other central depressant drugs
* Known allergy against haloperidol or other butyrophenones or other drug ingredients


=== Special caution needed ===
<!--Use in Specific Populations-->
* Preexisting [[Parkinson's disease]]
|useInPregnancyFDA=* '''Pregnancy Category'''
* Patients at special risk for the development of [[Long QT syndrome|QT prolongation]] ([[hypokalemia]], concomitant use of other drugs causing QT prolongation)
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
* Compromised [[liver]]-function (as haloperidol is metabolized and eliminated mainly by the liver, dose reductions and/or spaced intervals may be needed)
* Haloperidol may decrease the seizure-threshold.  Treat patients with [[epilepsy]] and those with risk factors for the development of seizures (alcohol withdrawal, encephalopathy) with caution.  Maintain existing anticonvulsive therapy.
* Patients with hyperthyreosis; the action of haloperidol is intensified and side-effects are more likely.  Initiate an effective therapy of hyperthyreosis.
* IV injections: inject slowly to avoid hypotension or orthostatic collapse.  Avoid IV injections in cardiovascular unstable patients (preexisting hypotension, shock, concomitant antihypertensive therapy, heart insufficiency).  Prefer in these cases moderate oral or IM doses.


==Adverse effects==
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
The drug is noted for its strong early and late [[extrapyramidal side-effect]]s.<ref name ="Joy07"/> The risk of the facial disfiguring [[tardive dyskinesia]] is around 4% per year in younger patients, higher than with most other antipsychotic drugs. In patients over the age of 45, the percentage of those afflicted can be even higher.  Other predispositive factors may be female gender, preexisting affective disorder and cerebral dysfunction.  
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


[[Akathisia]] manifests itself with anxiety, dysphoria, and an inability to remain motionless. High functioning patients have described the feeling as a sense of inner tension and torment or chemical [[torture]] from the inside out.
<!--Administration and Monitoring-->
|administration=* Oral


Other side effects include [[dry mouth]], [[lethargy]], restlessness of [[akathisia]], [[muscle]]-stiffness, muscle-cramping, restlessness, [[tremor]]s, and [[weight]]-gain; side effects like these are more likely to occur when the drug is given in high doses and/or during long-term treatment. [[clinical depression|Depression]], severe enough to result in [[suicide]], is quite often seen during long-term treatment. Care should be taken to detect and treat depression early in course.  Sometimes the change from haloperidol to a mildly potent neuroleptic (e.g. [[chlorprothixene]] or [[chlorpromazine]]), together with appropriate antidepressant therapy, does help.  Sedative and anticholinergic side-effects occur more frequently in the elderly.
* Intravenous
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.


The pontentially fatal [[neuroleptic malignant syndrome]] (NMS) is a significant possible side effect.  Haloperidol and [[fluphenazine]] are the two drugs which cause NMS most often.  NMS involves fever and other symptoms.  Allergic and toxic side-effects are uncommon.  Skin rash and photosensitivity both occur in less than 1% of patients.
* Description


Children and adolescents are particularly sensitive to the early and late extrapyramidal side-effects of haloperidol.  It is recommended to treat pediatric patients only if clearly needed and if the psychiatric or neurologic disorder is substantial.
<!--IV Compatibility-->
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.


[[Long QT syndrome|QT prolongation]] with sudden death is rarely seen. Likewise, the development of [[thrombosis|thromboembolic]] complications are also rare.
<!--Overdosage-->
|overdose====Acute Overdose===


Haloperidol may have a negative impact on vigilance or decrease the ability of the patient to drive or operate a machine, particularly initially.
====Signs and Symptoms====


Haloperidol is completely devoid of any potential psychological dependence. A greater problem is that psychiatric patients prescribed this drug may seek to avoid taking it and consequently risk relapse of their symptoms.
* Description


Unpleasant withdrawal symptoms, if haloperidol is stopped abruptly after long-term treatment, are sometimes noted.  These are usually agitation, anxiety, insomnia, and nausea. But agitation is also a side effect of this drug because of [[akathisia]]. Rebound of psychotic symptoms and mood swing into mania are also seen.
====Management====


==Other Remarks==
* Description
During long-term treatment of chronic psychiatric disorders, it should be tried - in regular intervals - to reduce the daily dose to the lowest level needed for maintenance of remission.  Sometimes, it may be indicated to terminate haloperidol treatment gradually.


Other forms of therapy (psychotherapy, occupational therapy/ergotherapie, social rehabilitation) should be instituted properly.
===Chronic Overdose===


==Pregnancy and lactation==
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
Data from [[Animal testing|animal experiments]] indicate haloperidol is not [[teratogenic]], but is [[embryotoxic]] in high doses.  In humans, no controlled studies exist.  Unconfirmed studies in pregnant women revealed possible damage to the fetus, although most of the women were exposed to multiple drugs during pregnancy.  Following accepted general principles, haloperidol should only be given during pregnancy if the benefit to the mother clearly outweighs the potential fetal risk.


Haloperidol, when given to lactating women, is found in significant amounts in their milk.  Breastfed children sometimes show extrapyramidal symptoms.  If the use of haloperidol during lactation seems indicated, the benefit for the mother should clearly outweigh the risk for the child. Consider termination of breastfeeding.
<!--Pharmacology-->


== Carcinogenicity ==
<!--Drug box 2-->
So far, no statistically acceptable evidence is found to associate long-term use of haloperidol with the potential for increased breast cancer risk in female patients.  In an unconfirmed study, relative risks of breast cancer, in inmates of the [[Buffalo Psychiatric Center]] undergoing long-term treatment with haloperidol, were 3.5 (compared to patients hospitalized in general or internal medicine facilities) and 9.5 (general population), respectively (authors: U. Halbreich et al, loc. cit.: 'American Journal of Psychiatry', 1996).  These results need confirmation by larger studies.  If true, carcinogenity is most probably related to the strong increase in plasma-levels of [[prolactin]] under long-term treatment with haloperidol.  This news is another good reason to avoid any unnecessary use of haloperidol.
|drugBox=<!--Mechanism of Action-->
|mechAction=*


==Interactions==
<!--Structure-->
* Other central depressants (alcohol, tranquilizers, narcotics):  actions and side-effects of these drugs (sedation, respiratory depression) are increased.  In particular, the doses of concomitantly used opioids for chronic pain can be reduced by 50%.
|structure=*  
* [[Methyldopa]]:  increased risk of extrapyramidal side-effects and other unwanted central effects
* [[Levodopa]]:  decreased action of levodopa
* [[Tricyclic antidepressants]]:  metabolism and elimination of tricyclics significantly decreased, increased toxicity noted (anticholinergic and cardiovascular side-effects, lowering of seizure-threshold)
* [[Quinidine]], [[buspirone]], and [[fluoxetine]]:  increased plasma-levels of haloperidol, decrease haloperidol dose, if necessary
* [[Carbamazepine]], [[phenobarbital]], and [[rifampicin]]:  plasma-levels of haloperidol significantly decreased, increase haloperidol dose, if necessary.
* [[Lithium salt|lithium]]:  rare cases of the following symptoms have been noted:  [[encephalopathy]], early and late extrapyramidal side-effects, other neurologic symptoms and coma.  Check lithium plasma levels regularly and keep the dose of haloperidol as low as possible.
* [[Guanethidine]]:  antihypertensive action antagonized
* [[Epinephrine]]:  action antagonized, paradoxical decrease in blood pressure may result


==Doses==
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
As directed by the physician, depends on the condition to be treated, age and weight of patient:


* Acute problems: single doses of 1 mg to 5 mg (up to 10mg) oral or i.m., usually repeated every 4 to 8 hours. Do not exceed an oral dose of 100 mg daily. Doses used for IV injection are usually 5 to 10 mg as a single dose; not exceeding 50 mg daily.
<!--Pharmacodynamics-->
* Chronic conditions: 0.5 to 20 mg daily oral, rarely more. The lowest dose that maintains remission should be employed.
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
* Experimental doses:  In resistant cases of psychosis small studies with oral doses of up to 300 mg daily have been conducted (in most cases together with an anticholinergic antiparkinsonian drug (Biperiden, Benzatropine, etc.) to avoid severe early extrapyramidal side-effects. These studies showed no superior results and led to severe side-effects. Also, the frequency of otherwise unusual side-effects (hypotension, QT-time prolongation, and serious [[cardiac arrhythmia]]s) was dramatically increased. The clinical use of haloperidol in these doses is discouraged now and it is recommended to switch the patient gradually to a different neuroleptic (e.g. clozapine, olanzapine, aripiprazole).


Depot forms are also available; these are injected deeply i.m. at regular intervals. The depot forms are not suitable for initial treatment
<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.


==Overdose==
<!--Nonclinical Toxicology-->
Experimental evidence from animal studies indicates that doses needed for acute poisoning are quite high in relation to therapeutic doses.
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.


Symptoms are usually due to exaggerated side-effects. Most often encountered are:
<!--Clinical Studies-->
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.


* Severe extrapyramidal side-effects with muscle rigidity and tremors, akathisia etc. (inject 5 mg biperiden (Akineton®) slowly IV, repeat after some hours if necessary). Sometimes oral or IM treatment with biperiden is needed for several days or even weeks. If the patient is very upset about extrapyramidal side-effects, small doses of lorazepam (0.5 to 1 mg orally, repeated every 4 to 6 hours if necessary) can be given. Lorazepam has an intrinsic action against upset, anxiety, and extrapyramidal side-effects.
<!--How Supplied-->
* Hypotension or hypertension
|howSupplied=*  
* Sedation
* Anticholinergic side-effects (dry mouth, constipation, paralytic ileus, difficulties in urinating, massive sweating). Cautious doses of physostigmine may be given repeatedly. '''N.B. Physostigmine may increase the risk of seizures!'''
* Coma in severe cases, accompanied by respiratory depression and massive hypotension, shock
* Rarely serious ventricular arrhythmia (torsades de pointes) with or without prolonged QT-time
* Epileptic seizures, give careful doses of diazepam 5 mg to 10 mg by slow IV injection, repeatedly if needed, until seizures subside. Take care not to worsen central depression or respiratory depression caused by haloperidol.  The treatment facility should be able to institute artificial respiration readily. Valproate first given as slow IV infusion and later orally may also be effective.


Treatment is merely symptomatic and involves intensive care with stabilization of vital functions.  In early detected cases of oral overdose induction of emesis, gastric lavage and the use of activated charcoal can all be tried.  Avoid epinephrine for treatment of hypotension and shock, because its action might be reversed.
<!--Patient Counseling Information-->
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.


Generally, the prognosis of overdose is good and lasting damage is not known, provided that the patient has survived the initial phase.
<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


Overdoses with depot injections are uncommon, because almost always experienced personnel administer them to patients.
<!--Brand Names-->
|brandNames=* ®<ref>{{Cite web | title =  | url =  }}</ref>


==Other formulations==
<!--Look-Alike Drug Names-->
[[Image:Haloperidol decanoate highlighting ester group.svg|thumb|[[Skeletal formula]] of haloperidol decanoate. The decanoate group is highlighted in {{color|blue|blue}}.]]
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>
The [[decanoate]] ester of haloperidol (Haloperidol decanoate, trade names '''Haldol decanoate''', '''Halomonth''', '''Neoperidole''') has a much longer duration of action, and therefore is used in noncompliant people. A dose of 25&nbsp;to 250&nbsp;mg is given by intramuscular injection once every two to four weeks.<ref>Goodman and Gilman's ''Pharmacological Basis of Therapeutics, 10th edition'' (McGraw-Hill, 2001).</ref>  


The [[IUPAC name]] of haloperidol decanoate is 4-(4-chlorophenyl)-1-1[4-(4-fluorophenyl)-4-oxobutyl]-4 piperidinyl decanoate.
<!--Drug Shortage Status-->
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
<!--Pill Image-->


==Veterinary use==
Haloperidol is also used on many different kinds of animals.  It appears to be particularly successful when given to birds; e.g. a parrot that will not otherwise stop plucking its feathers out.


==Dose forms==
* Liquid:  2 mg/mL, also 10 mg/mL
* Tablets:  0,5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg
* Injection:  5 mg (1 mL)
* Depot injection forms
* The original drug Haldol and many generics are available


==See also==
<!--Label Display Image-->
* [[Biological psychiatry]]


==References==
{{Reflist}}
* B. Bandelow, S. Bleich, S. Kropp: Handbuch Psychopharmaka (German), 2nd. edition, 2004
* Benkert, Hippius: Kompendium der Psychiatrischen Pharmakotherapie (German), 4th. edition, 2003
* Schweizer Arzneimittelkompendium (German): Scientific Information on Haldol


{{Antipsychotics}}
{{Dopamine antagonists}}


[[de:Haloperidol]]
[[et:Haloperidool]]
[[es:Haloperidol]]
[[fr:Halopéridol]]
[[it:Aloperidolo]]
[[hu:Haloperidol]]
[[nl:Haloperidol]]
[[ja:ハロペリドール]]
[[pt:Haloperidol]]
[[ru:Галоперидол]]
[[fi:Haloperidoli]]
[[sv:Haloperidol]]
[[tr:Haloperidol]]


[[Category:Typical antipsychotics]]
[[Category:Antiemetics]]
[[Category:Organofluorides]]
[[Category:Organochlorides]]
[[Category:Amines]]
[[Category:Alcohols]]
[[Category:Ketones]]


[[Category:Overview complete]]
<!--Category-->
[[Category:Drugs]]


[[pl:Haloperidol]]
[[Category:Drug]]
{{WH}}
{{WikiDoc Sources}}

Revision as of 17:39, 11 December 2014

Haloperidol (tablet)
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

Disclaimer

WikiDoc MAKES NO GUARANTEE OF VALIDITY. WikiDoc is not a professional health care provider, nor is it a suitable replacement for a licensed healthcare provider. WikiDoc is intended to be an educational tool, not a tool for any form of healthcare delivery. The educational content on WikiDoc drug pages is based upon the FDA package insert, National Library of Medicine content and practice guidelines / consensus statements. WikiDoc does not promote the administration of any medication or device that is not consistent with its labeling. Please read our full disclaimer here.

Black Box Warning

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Haloperidol (tablet) is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
  • Dosing Information
  • Dosage
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Haloperidol (tablet) in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Haloperidol (tablet) in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Haloperidol (tablet) in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Haloperidol (tablet) in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Haloperidol (tablet) in pediatric patients.

Contraindications

  • Condition1

Warnings

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Haloperidol (tablet) in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Haloperidol (tablet) in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Haloperidol (tablet) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Haloperidol (tablet) during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Haloperidol (tablet) with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Haloperidol (tablet) with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Haloperidol (tablet) with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Haloperidol (tablet) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Haloperidol (tablet) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Haloperidol (tablet) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Haloperidol (tablet) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Haloperidol (tablet) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Haloperidol (tablet) in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Haloperidol (tablet) in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Haloperidol (tablet) in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Haloperidol (tablet) in the drug label.

Pharmacology

There is limited information regarding Haloperidol (tablet) Pharmacology in the drug label.

Mechanism of Action

Structure

File:Haloperidol (tablet)01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Haloperidol (tablet) in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Haloperidol (tablet) in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Haloperidol (tablet) in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Haloperidol (tablet) in the drug label.

How Supplied

Storage

There is limited information regarding Haloperidol (tablet) Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Haloperidol (tablet) |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Haloperidol (tablet) |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Haloperidol (tablet) in the drug label.

Precautions with Alcohol

  • Alcohol-Haloperidol (tablet) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. Empty citation (help)
  2. "http://www.ismp.org". External link in |title= (help)

{{#subobject:

 |Page Name=Haloperidol (tablet)
 |Pill Name=No image.jpg
 |Drug Name=
 |Pill Ingred=|+sep=;
 |Pill Imprint=
 |Pill Dosage={{{dosageValue}}} {{{dosageUnit}}}
 |Pill Color=|+sep=;
 |Pill Shape=
 |Pill Size (mm)=
 |Pill Scoring=
 |Pill Image=
 |Drug Author=
 |NDC=

}}

{{#subobject:

 |Label Page=Haloperidol (tablet)
 |Label Name=Haloperidol (tablet)11.png

}}

{{#subobject:

 |Label Page=Haloperidol (tablet)
 |Label Name=Haloperidol (tablet)11.png

}}