[, Seeman P: Atypical antipsychotics: mechanism of action. Avoid combination, Guanethidine: Antipsychotic Agents may diminish the therapeutic effect of Guanethidine. When possible, consider avoiding concurrent use. Avoid combination, Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Additional monitoring parameters with IV administration: ECG (prior to administration and regularly [eg, daily] during administration to detect emerging QTc interval prolongation) (Drew 2010); serum potassium and magnesium (prior to administration); continuous cardiac monitoring (during administration and 2 to 3 hours after administration) (Drew 2010; Jibson 2019). Avoid combination, Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Patients with additional risk factors for QTc prolongation may be at even higher risk. and transmitted securely. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. Read on to find out how tea may help you. Management: Consider alternatives to this drug combination. J Neurosci. Hepatic: 50% to 60% glucuronidation (inactive); 23% CYP3A4-mediated reduction to inactive metabolites (some back-oxidation to haloperidol); and 20% to 30% CYP3A4-mediated N-dealkylation, including minor oxidation pathway to toxic pyridinium derivative (Kudo 1999). Note: Higher doses may be necessary in severe or refractory cases (Kliegman 2011). Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. When switching antipsychotics, three strategies have been suggested: Cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). Avoid in suspected or confirmed intoxications with anticholinergic substances; other agents are used preferentially in some intoxications (eg, stimulants) or alcohol withdrawal. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. Sometimes haloperidol must be taken for several days to several weeks before its full effect is reached. This is not a complete list of side effects and others may occur. Data from a meta-analysis of randomized trials support the use of haloperidol for patients experiencing manic or mixed episodes and shows a faster onset of action compared to second-generation antipsychotics Goikolea 2013. Many drugs besides haloperidol may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, quinidine, sotalol, procainamide, macrolide antibiotics (such as erythromycin), among others. Use of the first-generation antipsychotics (including haloperidol) is considered highly effective for the management of the "positive" symptoms of schizophrenia including hallucinations, hearing voices, aggression/hostility, disorganized speech, and psychomotor agitation. 2015 Jan 16;1:CD009831. J Pharmacol Exp Ther. Following intramuscular injection, mean half-life was found to be 20.7 hours.3, Following intravenous administration, the plasma or serum clearance (CL) was found to be 0.39-0.708 L/h/kg (6.5 to 11.8 ml/min/kg). Build, train, & validate predictive machine-learning models with structured datasets. Drug Metab Dispos. For females, this increase in prolactin may result in unwanted breast milk, missed/stopped periods, or difficulty becoming pregnant. Management: Consider alternatives to this drug combination. Avoid combination, Piribedil: Antipsychotic Agents may diminish the therapeutic effect of Piribedil. Before taking haloperidol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Haloperidol is usually dosed two to three times daily. Usual maintenance dose is 10 to 15 times the previous daily oral dose administered at 4-week intervals. In a small case-series, loading doses of 0.025 to 0.1 mg/kg/dose administered every 10 minutes until sedation achieved (reported total haloperidol loading dose: 0.09 to 0.25 mg/kg total) followed by maintenance doses of 0.06 to 0.45 mg/kg/day in divided doses every 6 to 8 hours were described (n=5; age range: 9 months to 16 years); infants (n=2) were noted to require lower doses (total loading dose: 0.09 to 0.1 mg/kg total; maintenance: 0.015 to 0.025 mg/kg/dose every 6 hours); one patient experienced a dystonic reaction (Harrison 2002), Children 3 to 12 years weighing 15 to 40 kg: Oral: Initial: 0.5 mg/day in 2 to 3 divided doses; increase by 0.5 mg every 5 to 7 days to usual maintenance range of 0.05 to 0.15 mg/kg/day in 2 to 3 divided doses (maintenance range calculates to a fixed dose of 0.75 to 6 mg/day in divided doses); higher doses may be necessary in severe or refractory cases; maximum dose not established; in adolescents, the maximum daily dose is 15 mg/day (Kliegman 2011). Maximum dose: 450 mg every 4 weeks. Peak effect: Lactate: IV: Sedation: ~30 minutes (Forsman 1976; Jacobi 2002; Magliozzi 1985). If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Consider therapy modification, HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Get up slowly when rising from a sitting or lying position. Consider continuous ECG monitoring, especially if the patient has risk factors for QTc prolongation, the baseline ECG reveals a prolonged QTc, or cumulative doses of 2 mg are needed. IV: Sedation: 3 to 20 minutes (Jacobi 2002). attention, aggressivity, mood lability, and poor frustration tolerance). Adjust dose based on response and tolerability. Perhexiline may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Can J Psychiatry. Monitor therapy, CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Consider therapy modification, Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Neuroleptic malignant syndrome (NMS): Use may be associated with NMS; monitor for mental status changes, fever, muscle rigidity, and/or autonomic instability. 1991 May;33(1):1-17. doi: 10.1080/15287399109531501. Complete fall risk assessments at baseline and periodically during treatment in patients with diseases or on medications that may also increase fall risk. doi: 10.18553/jmcp.2012.18.s5-b.1. 5. Risk of QT prolongation, torsade de pointes, and sudden death appear to be increased with intravenous administration, particularly at higher doses. Non-ICU (off-label use): IM, IV (off-label route) (lactate injection), Oral: Initial: 0.5 to 1 mg; if needed, may repeat every 30 minutes until calm. Monitor therapy, Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Orthostatic hypotension: May cause orthostatic hypotension; use with caution in patients at risk of this effect or in those who would not tolerate transient hypotensive episodes (cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use that may predispose to hypotension/bradycardia). Although the causes of death were varied, most of the deaths appeared to be cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. In addition, they block many receptors other than the primary target (dopamine receptors), such as cholinergic or histaminergic receptors, resulting in a higher incidence of side effects such as sedation, weight gain, and hypotension. Cochrane Database Syst Rev. Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (99 mg/kg/day) have been associated with a potentially fatal toxicity (gasping syndrome) in neonates; the gasping syndrome consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. [, Tadori Y, Forbes RA, McQuade RD, Kikuchi T: Characterization of aripiprazole partial agonist activity at human dopamine D3 receptors. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur. This document does not contain all possible drug interactions. Monitor therapy, Serotonergic Agents (High Risk): May enhance the adverse/toxic effect of Antipsychotic Agents. Consider therapy modification, Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. IM (lactate injection) to oral: Use the total IM (as lactate) dose administered in the preceding 24 hours as an initial approximation of the total daily dose requirement for the oral formulation. [, Naiker DV, Catts SV, Catts VS, Bedi KS, Bryan-Lluka LJ: Dose determination of haloperidol, risperidone and olanzapine using an in vivo dopamine D2-receptor occupancy method in the rat. . Protect from light. The plasma concentrations of haloperidol gradually rise, reaching its peak concentration at about 6 days after the injection, with an apparent half-life of about 21 days. Avoid combination, Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Administration of haloperidol decanoate (the depot form of haloperidol for long-term treatment) in sesame oil results in slow release of the drug for long-term effects. Data from a meta-analysis of randomized trials support the use of IM haloperidol in the treatment of agitation and/or aggression due to psychosis. Drug Metab Dispos. Consider therapy modification, Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy, Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy, Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Haloperidol is a high potency first-generation (typical) antipsychotic and one of the most frequently used antipsychotic medications used worldwide.7 While haloperidol has demonstrated pharmacologic activity at a number of receptors in the brain,10 it exerts its antipsychotic effect through its strong antagonism of the dopamine receptor (mainly D2), particularly within the mesolimbic and mesocortical systems of the brain. Monitor therapy, QT-prolonging Agents (Indeterminate Risk - Avoid): May enhance the QTc-prolonging effect of Haloperidol. Should I avoid certain foods while taking Haloperidol? Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. Avoid combination, Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. 2006 Mar-Apr;32(2 Pt 1):263-9. Haloperidol should be reserved for these two groups of children only after failure to respond to psychotherapy or medications other than antipsychotics.16. Discontinuation of therapy: Gradual dose reduction is advised to avoid withdrawal symptoms (ie, insomnia, headache, GI symptoms) unless discontinuation is due to significant adverse effects. Clinical experience also suggests the utility of haloperidol in managing breakthrough episodes of CINV in adults Lohr 2008. J Psychiatr Res. Specifically, the risk for seizures may be increased. Ther Drug Monit. Esophageal dysmotility/aspiration: Antipsychotic use has been associated with esophageal dysmotility and aspiration; risk increases with age. This product is available in the following dosage forms: Tablet Summary of the comparative effectiveness review on off-label use of atypical antipsychotics. 2015 Jan 16;1:CD009831. Tourette syndrome, management of tics (alternative agent): Oral: Initial: 1 to 2 mg/day in 1 to 3 divided doses; may increase dose based on response and tolerability in increments of 0.5 to 2 mg every 2 to 3 days up to 12 mg/day. It is used to treat problems with how one acts. Consult appropriate manufacturer labeling. Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Tell your doctor if your symptoms do not improve or if they worsen. Improve clinical decision support with information on. 2007 Jul;28(7):953-8. Unable to load your collection due to an error, Unable to load your delegates due to an error. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. It starts to work very quickly, so it is taken when you anticipate having sex, rather than every day. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Low sodium like headache, difficulty focusing, trouble with memory, confusion, weakness, seizures, or change in balance. The site is secure. Society of Critical Care Medicine guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU, Multinational Association of Supportive Care in Cancer and European Society for Medical Oncology (MASCC/ESMO) 2016 guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients, MASCC/ESMO 2016 updated consensus recommendations for management of nausea and vomiting in advanced cancer, Society for Ambulatory Anesthesia consensus guidelines for the management of postoperative nausea and vomiting. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Chemotherapy-induced breakthrough nausea and vomitingcyes. Severe extrapyramidal symptoms have occurred in some patients. Consider therapy modification, Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Explore careers. Tourette syndrome, management of tics (tablet, concentrate, IM lactate): Control of tics and vocal utterances in Tourette syndrome in adults and children. Consider therapy modification, Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Lithium may decrease the serum concentration of Antipsychotic Agents. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. In general, when discontinuing antipsychotic therapy for a chronic psychiatric disorder (eg, schizophrenia, bipolar disorder), decreasing the dose very gradually over weeks to months (eg, reducing the dose by 10% per month) with close monitoring is suggested to allow for detection of prodromal symptoms of disease recurrence (APA [Lehman 2004]; CPA 2005). Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Consider therapy modification, Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. 2008 Nov 12;597(1-3):27-33. doi: 10.1016/j.ejphar.2008.09.008. Patients with additional risk factors for QTc prolongation may be at even higher risk. Due to the risk of unpleasant and sometimes lifelong extrapyramidal symptoms, newer antipsychotic medications than haloperidol have been discovered and formulated. Falls: May increase the risk for falls due to somnolence, orthostatic hypotension, and motor or sensory instability. Avoid combination, Lemborexant: May enhance the CNS depressant effect of CNS Depressants. In: StatPearls [Internet]. Monitor therapy, Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy, Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). This medication may rarely cause a condition known as tardive dyskinesia. Monitor therapy, Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. 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