haloperidol (Haldol, Halperon, Aloperidol, Halomonth)

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Introduction

Tradenames: Haldol, Halperon.

Indications

* haloperidol 1.0-3.8 mg QD for 3-11 days associated with very-small dose-dependent improvement in survival of critically-ill patients with delirium (RR=0.91-0.95 at 28 days, 0.96-0.98 at 90 days)[14]

* no better than placebo for treatment of delirium in ICU patients[15]

Contraindications

Caution:

pregnancy category = c

safety in lactation = ?

Dosage

Tabs: 0.5, 1, 2, 5, 10, 20 mg.

Liquid: 2 mg/5 mL.

Pharmacokinetics

elimination via liver

elimination via kidney

1/2life = 12-24 hours

protein binding = 90 %

elimination by hemodialysis = -

elimination by peritoneal dialysis = -

Monitor

Adverse effects

Drug interactions

Laboratory

Mechanism of action

More general terms

Additional terms

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1147
  3. 3.0 3.1 Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  5. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  6. Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
  7. 7.0 7.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  8. 8.0 8.1 Rosenheck R et al Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial.. JAMA 290:2693, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14645311
  9. 9.0 9.1 Schneeweiss S et al, Risk of death with use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ 2007, 176:627 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17325327
  10. 10.0 10.1 Prescriber's Letter 14(11): 2007 Intravenous Haloperidol (Haldol) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=231110&pb=PRL (subscription needed) http://www.prescribersletter.com
  11. 11.0 11.1 11.2 11.3 11.4 11.5 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  12. 12.0 12.1 Weeke P et al. Antipsychotics and associated risk of out-of-hospital cardiac arrest. Clin Pharmacol Ther 2014 Jun 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24960522
  13. van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999 Sep 4;319(7210):623-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10473482 Free PMC article
  14. 14.0 14.1 Duprey MS, Devlin JW, van der Hoeven JG et al Association Between Incident Delirium Treatment With Haloperidol and Mortality in Critically Ill Adults. Crit Care Med. 2021;49(8):1303-1311. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33861548 PMCID: PMC8282692 (available on 2022-08-01) https://www.medscape.com/viewarticle/955328
  15. 15.0 15.1 George J Haloperidol for ICU Delirium Misses on Hard Endpoints. No difference from placebo on composite outcome in randomized trial. MedPage Today October 27, 2022 https://www.medpagetoday.com/neurology/generalneurology/101460
    Andersen-Ranberg NC, Poulsen LM, Perner A et al Haloperidol for the Treatment of Delirium in ICU Patients. N Eng J Med. 2022. Oct 26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36286254 https://www.nejm.org/doi/full/10.1056/NEJMoa2211868
  16. Episode 785: Haloperidol for Agitation in Elderly Patients - How Low Can You Go? Pharmacy Joe. Jan 23, 2023 https://www.pharmacyjoe.com/haloperidol-for-agitation-in-elderly-patients-how-low-can-you-go/
    Yuksel JM et al Optimal Injectable Haloperidol Dose Assessment in the Older Hospitalized Inpatient. Annals of Pharmacotherapy. 2022. Sep 13;10600280221124615 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36113417 https://journals.sagepub.com/doi/10.1177/10600280221124615

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