Haloperidol
INDICATIONS:
- Schizophrenia
- Tourette disorder
- Acute psychosis
- Agitated State
- Morbid grief
- Antagonism of dopamine actions
- Hyperactivity, aggression
- Nausea & emesis caused by cancer drugs.
- Alcohol withdrawal syndrome
- Intractable hiccups.
CONTRAINDICATION:
- Allergic to dopaminergic receptor antagonist/any ingredient in Haloperidol.
- Parkinsonism.
- Coma.
- During severe central nervous system depression.
- Eg: Severe drowsiness & Slow or shallow breathing.
- Severely low levels of white blood cells.
- Mainly neutrophils.
On drugs:
- Astemizole.
- Dofetilide.
- Dronedarone.
- Nilotinib.
- Propafenone.
- Sodium oxybate (GHB).
- Terfenadine/tetrabenazine
SIDE EFFECTS:
More common:
- Extra-pyramidal side effects: (Significant)
- Acute dystonia
- Tongue protrusion
- Oculogyric crisis
- Stiffness of the arms and legs
- Neuroleptic malignant syndrome
- Hyperpyrexia, muscle rigidity, akinesia, mutism, sweating, tachycardia, high BP.
- Uncontrolled movements of arms & legs (akathisia)
- Severe restlessness – (treated with β-blocker).
- Fidgety & irritability
- Mask-like face.
- Inability to move the eyes.
- Muscle spasms, especially of neck & back.
- Difficulty with speaking or swallowing
- Weakness of arms and legs.
- Shuffling walk
- Trembling & shaking of fingers & hands
- Mainly on decreasing the dose(withdrawal dyskinesia)
- Twisting movements of body
- Loss of balance control
OVERDOSE:
- Symptoms
- Severe extrapyramidal side effects with muscle rigidity & tremors, akathisia, etc.
- Hypotension or hypertension
- Sedation
Anticholinergic side effects:
- Dry mouth.
- Constipation.
- Paralytic ileus.
- Difficulties in urinating.
- Decreased perspiration.
- Coma in severe cases, accompanied by respiratory depression and massive hypotension, shock
- Rarely, serious ventricular arrhythmia with or without prolonged QT-time
TREATMENT:
- Is symptomatic.
- Involves intensive care with stabilization of vital functions.
- ECG & vital signs should be monitored.
- Especially for QT prolongation.
- Severe arrhythmias treated with antiarrhythmic measures.
Early cases:
- Induction of emesis, gastric lavage, and use of activated charcoal
Severe overdose:
- Dopamine receptor agonists
- Antidotes: Bromocryptine/Ropinirole used to treat extrapyramidal effects.
Exam Question
- Involuntary movements of this hands, feet, lips, and tongue will increase initially as the medication is decreased
- Haloperidol toxicity can cause Akathisia
- Long QT is seen as effect of overdosing of haloperidol.
- The most common side effect reported with treatment with haloperidol is Akathisia
- Depot preparations are available for Haloperidol.
- A week after the initiation of Haloperidol the patient shows be restlessness, fidgety, irritability and cannot sit still at one place can be treated with beta-blockers.
- Acute drug dystonia shows abnormal movements like induced persistent deviation of neck on one side is seen with haloperidol.
- Tongue protrusion, oculogyric crisis, stiffness and abnormal posture of limbs and trunk without loss of consciousness for last 20 minutes after administration of haloperidol suggest acute dystonia.
- Hyperpyrexia, muscle rigidity, akinesia, mutism, sweating, tachycardia, high BP after administration of haloperidol suggest Neuroleptic malignant syndrome.
- Drug treatment of schizophrenic is haloperidol.
- Treatment of morbid grief showing Preoccupation with the memory of deceased is Haloperidol.
- Effect of dopamine on kidney is blocked by Haloperidol.
- Extrapyramidal syndrome like side effects are seen in haloperidol.
Don’t Forget to Solve all the previous Year Question asked on Haloperidol