Haloperidol.pptx

Haldol

1. Haloperidol Franklin N. Alier, MD PGY-2 SIU Psychiatry Springfield, IL

2. Haloperidol / Haldol First discovered by a Belgian physician named Paul Janssen It was developed in 1958 by Janssen Pharmaceutica and submitted for its first clinical trials in Belgium later that year It was approved by the FDA in April of 1967 and was later marketed under the name Haldol by McNeil Laboratories

3. Haloperidol First generation (typical ) antipsychotic Black box warning : “Elderly patients with dementia related psychosis treated with antipsychotic drugs are at an increased risk of death.” Data: 4.5% increased risk of death in exposed group vs 2.6% in placebo group. Most deaths were cardiovascular in nature.

4. Haldol - Adult Dosing: Manufacturer’s label : Maximum recommended dose is 100 mg per day, however studies have shown the risk/benefit ratio is not as favorable when doses exceed 30 mg qday . (Moore 2020) Dose dependent QT Prolongation is seen in doses above 2 mg Formulations : Oral, IM or IV. Short acting injection (Lactate) and Long acting injection ( D ecanoate )

5. Haldol: Renal Dosing vs Hepatic Dosing Renal impairment / Hemodialysis / Peritoneal Dialysis : No adjustment necessary Hepatic impairment: Manufacturer does not provide dosage adjustments for hepatic impairment. However, since Haloperidol is mainly metabolized by the liver, haloperidol levels may be increased in patients with hepatic impairment.

6. Pediatric dosing: Acute agitation : Children under 40 kg (88 lbs ): 6 mg qday maximum Children over 40 kg (88 lbs ): 15 mg qday maximum Children: 0.5 mg – 2 mg , repeat every 1 to 2 hours not to exceed daily maximum Adolescents : 2 mg – 5 mg , repeat every 1 to 2 hours not to exceed daily maximum

7. Labeled indications: Behavioral disorders (non-psychotic): Treatment of severe behavioral problems in children with combative, explosive hyper-excitability. Hyperactivity : Short term treatment of children who show excessive motor activity with accompanying conduct disorders: impulsivity, difficulty sustaining attention, aggression, mood lability, poor frustration tolerance. Schizophrenia Tourette Syndrome – Control of tics and vocal utterances in adults and children

8. Off label indications: Agitation – severe, acute, associated with psychiatric disorders, substance intoxication or other organic causes Bipolar disorder Chemotherapy induced breakthrough nausea and vomiting Delirium (hyperactive)

9. Mechanism of action Non-selectively blocks post-synaptic dopaminergic D2 receptors in the brain

10. Adverse reactions Extrapyramidal symptoms (Acute dystonia, Akathisia, Drug Induced Parkinsonism, Tardive Dyskinesia) Important: Dysphagia/Esophageal dysmotility or pulmonary aspiration have also been reported and may not initially be recognized as EPS