Haloperidol

Haloperidol

[1 vial IV $1.71]

ADMINISTRATION ROUTES:

  • IV, IM, PO

ALTERNATIVE NAMES:

  • Serenace

    Note: this monograph does not apply to Haldol (Haloperidol decanoate) which has an extended duration of action, is administered by IM depot injection and is not used in ICU

ICU INDICATIONS:

  1. delirium
  2. psychosis

PRESENTATION AND ADMINISTRATION:

  • IV:
    Haloperidol 5mg in 1ml (solution)
    Administer slowly over 1-2 minutes or as a bolus, undiluted or diluted in 5-10ml of normal saline. May be diluted in compatible IV fluid and administered over 10-30 minutes
    Undiluted solution may discolour if exposed to light. Discoloured solutions should not be used. Compatible with the following IV fluid subject to concentration limits:
    - Normal saline: up to a concentration of 0.75mg/ml
    - 5% dextrose: up to a concentration of 3mg/ml
    - Glucose and sodium chloride: up to a concentration of 1mg/ml
    - Hartmanns: up to a concentration of 1mg/ml
    Store at room temperature and protect from light
  • PO:
    Tablets:
    Serenace 0.5mg tablets (green), Serenace 1.5mg (white), Serenace 5mg (red)
    Liquid:
    Serenace 2mg/ml (20 drops is equal to 1ml)

DOSAGE:

  • IV/IM:
    ICU delirium and psychosis
    0.5mg-10mg as required. Usual maximum daily dose is 100mg although much higher doses have been described.
  • PO:
    0.5mg-20mg as required. Usual maximum daily dose is 100mg although much higher doses have been described.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)] — To be completed*
  • Dose in renal replacement therapy — To be completed*

DOSAGE IN PAEDIATRICS:

  • IV, IM, PO 0.01mg/kg daily; increased to 0.1mg/kg 12 hourly

CLINICAL PHARMACOLOGY:

  • Haloperidol is the first of the butyrophenone series of major tranquilizers. The precise mechanism of action has not been clearly established.

CONTRAINDICATIONS:

  1. Hypersensitivity to haloperidol
  2. Parkinson’sdisease

WARNINGS

  • Tardive Dyskinesia
    A syndrome consisting of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs. The syndrome usually develops with high doses given over a prolonged period; however, it can develop, although much less commonly, after relatively brief treatment periods at low doses.
  • Neuroleptic Malignant Syndrome (NMS)
    A potentially fatal symptom complexreferred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs.

PRECAUTIONS

  • General:
    Haloperidol may lower the seizure threshold Severe neurotoxicity (rigidity, inability to walk or talk) may occur in patients with thyrotoxicosis who are also receiving antipsychotic medication, including haloperidol.
  • Laboratory Tests: No tests in addition to routine ICU tests are required
  • Drug/Laboratory Test Interactions: None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Combined Use of Haloperidol and Lithium
    An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS) followed by irreversible brain damage has occurred in a few patients treated with lithium plus haloperidol. A causal relationship between these events and the concomitant administration of lithium and haloperidol has not been established; however, patients receiving such combined therapy should be monitored closely for early evidence of neurological toxicity and treatment discontinued promptly if such signs appear.

ADVERSE REACTIONS

  • Body as a Whole:
    Neuroleptic malignant syndrome (NMS), hyperpyrexia and heat stroke have been reported with haloperidol.
  • Central Nervous System:
    Extrapyramidal Symptoms (EPS), tardive dyskinesia, insomnia, restlessness, anxiety, euphoria, agitation, drowsiness, depression, lethargy, headache, confusion, vertigo, grand mal seizures, exacerbation of psychotic symptoms including hallucinations, and catatonic-like behavioral states
  • Cardiovascular:
    Tachycardia, hypotension, hypertension and ECG changes including prolongation of the Q-T interval and torsades de pointes.
  • Haematological: Mild and usually transient leukopenia and leukocytosis, minimal decreases in red blood cell counts, anaemia, or a tendency toward lymphomonocytosis.
    Agranulocytosis has rarely been reported to have occurred with the use of haloperidol, and then only in association with other medication.
  • Endocrine Disorders:
    Lactation, breast engorgement, mastalgia, menstrual irregularities, gynecomastia, impotence, increased libido, hyperglycemia, hypoglycemia and hyponatremia.
  • Gastrointestinal Effects:
    Anorexia, constipation, diarrhoea, hypersalivation, dyspepsia, jaundice, nausea and vomiting.
  • Autonomic Reactions:
    Dry mouth, blurred vision, urinary retention, diaphoresis and priapism.
  • Respiratory Effects:
    Laryngospasm, bronchospasm and increased depth of respiration.

Critical Care Drug Manual

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