Clinical Pharmacology Details


HALOPERIDOL


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Indications & Dose:

Nausea and vomiting



Adult: 1–2 mg


Nausea and vomiting in palliative care 



Adult: Initially 1.5 mg 1–2 times a day, increased if necessary to 5–10 mg daily in divided doses



Adult: 5–15 mg, to be administered over 24 hours



Adult: 2.5–10 mg/24 hours


Schizophrenia


Psychoses


Mania and hypomania


Organic brain damage (depending on symptoms) 



Adult: Initially 2–20 mg once daily, alternatively initially 2–20 mg daily in divided doses; maintenance 1–3 mg 3 times a day, adjusted according to response, daily maximum to be given in divided doses, for debilitated patients, use elderly dose; maximum 20 mg per day


Elderly: Initially 1–10 mg once daily, alternatively initially 1–10 mg daily in divided doses; maintenance 1–3 mg 3 times a day, adjusted according to response, daily maximum to be given in divided doses; maximum 20 mg per day 



Adult: Initially 2–5 mg, repeated if necessary, repeated dose given according to response and tolerability, for debilitated patients, use elderly dose; maximum 12 mg per day


Elderly: Initially 1–2.5 mg, repeated if necessary, repeated dose given according to response and tolerability; maximum 12 mg per day Agitation and restlessness in the elderly 



Elderly: Initially 0.75–1.5 mg 2–3 times a day adjusted according to response, if necessary Management of mental or behavioural problems such as aggression, hyperactivity and selfmutilation in patients with intellectual disabilities and in patients with organic brain damage (depending on symptoms)


Gilles de la Tourette syndrome


Severe tics


Intractable hiccup


Adjunct to short-term management of moderate to severe psychomotor agitation, excitement and, violent or dangerously impulsive behaviour



Adult: Initially 1.5–3 mg 2–3 times a day, alternatively initially 3–5 mg 2–3 times a day, higher dose in severely affected or resistant patients; maintenance 0.5–1 mg 3 times a day, increased if necessary to 2–3 mg 3 times a day, once symptoms are controlled, gradually reduce dose to the lowest effective maintenance dose, for debilitated patients, use elderly dose


Elderly: Initially 0.75–1.5 mg 2–3 times a day, alternatively initially 1.5–2.5 mg 2–3 times a day, higher dose in severely affected or resistant patients; maintenance 0.5–1 mg 3 times a day, increased if necessary to 2–3 mg 3 times a day, once symptoms are controlled, gradually reduce dose to the lowest effective maintenance dose


Restlessness and confusion in palliative care



Adult: 2 mg, then 2 mg every 2 hours if required



Adult: 2.5 mg, then 2.5 mg every 2 hours if required



Adult: 5–15 mg/24 hours

Contraindications:

 Severe toxic CNS depression, comatose states from any cause, Parkinson’s disease

Side Effects:

Cautions:

Precautions:

 Elderly, severe cardiac disorders, seizure disorder, hepatic dysfunction, child <3 yr, alcohol withdrawal, electroconvulsive therapy, abrupt withdrawal, glaucoma, COPD

Interaction:

Drugs


Anticholinergics: Inhibition of therapeutic effect of neuroleptics


Barbiturates: Potential reduction of serum neuroleptic concentrations


Bromocriptine: Inhibition of bromocriptineís ability to lower serum prolactin concentrations in patients with pituitary adenoma; theoretical inhibition of antipsychotic effects of neuroleptics


Carbamazepine: Decreased serum haloperidol concentrations


Guanethidine: Inhibition of antihypertensive effect of guanethidine


Levodopa: Inhibition of antiparkinsonian effects of levodopa


Lithium: Rare reports of severe neurotoxicity in patients receiving lithium and neuroleptics


Quinidine: Increases haldol concentrations; increased risk of toxicity.


 

Warnings:

Adverse Effects:

Lactations:

 Pregnancy Has been used for hyperemesis gravidarum, chorea gravidarum, and manic-depressive illness during pregnancy; excreted into breast milk; effect on nursing infant unknown, but may be of concern 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Agitation, anxiety, catatonic-like behavioral states, confusion, depression, drowsiness, EPS (pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia), euphoria, exacerbation of psychotic symptoms including hallucinations, headache, insomnia, lethargy, neuroleptic malignant syndrome, restlessness, seizures, vertigo


CV: ECG changes, hypertension, hypotension, tachycardia


EENT: Blurred vision, cataracts, dry eyes, glaucoma, retinopathy


GI: Anorexia, constipation, diarrhea, dry mouth, dyspepsia, hypersalivation, nausea, vomiting


GU: Priapism, urinary retention


HEME: Arganulocytosis, anemia, leukocytosis, minimal decreases in red blood cell counts, transient leukopenia.


METAB: Breast engorgement, gynecomastia, hyperglycemia, hyperprolactinemia, hypoglycemia, hyponatremia, impotence, increased libido, lactation, mastalgia, menstrual irregularities


RESP: Bronchospasm, increased depth of respiration, laryngospasm


SKIN: Diaphoresis, isolated cases of photosensitivity, loss of hair, maculopapular and acneiform skin reactions. 

Patient And Carer Advice: