Haloperidol

INDICATIONS:
  • Schizophrenia
  • Tourette disorder
  • Acute psychosis
  • Agitated State
  • Morbid grief
  • Antagonism of dopamine actions
  • Hyperactivity, aggression
  • Nausea and emesis
  • Alcohol withdrawal syndrome
  • Intractable hiccups
CONTRAINDICATION:
  • Allergic to any ingredient in haloperidol
  • Coma
  • Parkinsonism or have severe central nervous system depression (eg, severe drowsiness, slow or shallow breathing)
  • Severely low levels of certain white blood cells (neutrophils) 
  • On drugs astemizole, dofetilide, dronedarone, nilotinib, propafenone, sodium oxybate (GHB), terfenadine, or tetrabenazine
SIDE EFFECTS:
  1. More common:
  • Difficulty with speaking or swallowing
  • Inability to move the eyes
  • Loss of balance control
  • Acute dystonia
  1. Tongue protusion
  2. Oculogyric crisis
  3. Stiffness of the arms and legs
  • Neuroleptic malignant syndrome
  1. Hyperpyrexia, muscle rigidity, akinesia, mutism, sweating, tachycardia, high BP
  • Mask-like face
  • Muscle spasms, especially of the neck and back
  • Restlessness or need to keep moving (severe)(treated with β-blocker)
  • Fidgety, irritability 
  • Shuffling walk
  • Trembling and shaking of the fingers and hands on decreasing the dose(withdrawal dyskinesia)
  • Twisting movements of the body
  • Weakness of the arms and legs
Less common:
  • Decreased thirst
  • Difficulty in urination
  • Dizziness, lightheadedness, or fainting
  • Hallucinations (seeing or hearing things that are not there)
  • Lip smacking or puckering
  • Puffing of the cheeks
  • Rapid or worm-like movements of the tongue
  • Skin rash
  • Uncontrolled chewing movements
  • Uncontrolled movements of the arms and legs(akthisia)
Rare
  • Confusion
  • Convulsions (seizures)
  • Difficult or fast breathing
  • Fast heartbeat or irregular pulse
  • Fever (high)
  • High or low blood pressure
  • Hot, dry skin, or lack of sweating
  • Increased blinking or spasms of the eyelid
  • Increased sweating
  • Loss of bladder control
  • Muscle stiffness (severe)
  • Muscle weakness
  • Sore throat and fever
  • Uncontrolled twisting movements of the neck, trunk, arms, or legs
  • Unusual bleeding or bruising
  • Unusual facial expressions or body positions
  • Unusual tiredness or weakness
  • Unusually pale skin
  • Yellow eyes or skin
OVERDOSE:
  • Symptoms
  1. Severe extrapyramidal side effects with muscle rigidity and tremors, akathisia, etc.
  2. Hypotension or hypertension
  3. Sedation
  4. Anticholinergic side effects (dry mouth, constipation, paralytic ileus, difficulties in urinating, decreased perspiration)
  5. Coma in severe cases, accompanied by respiratory depression and massive hypotension, shock
  6. Rarely, serious ventricular arrhythmia with or without prolonged QT-time
  • Treatment
  • Symptomatic
  • Involves intensive care with stabilization of vital functions.
  • Early cases :Induction of emesis,gastric lavage, and use of activated charcoal 
  • Severe overdose :antidotes bromocryptine or ropinirole used to treat the extrapyramidal effects ( acting as dopamine receptor agonists.)
  • ECG and vital signs should be monitored especially for QT prolongation and severe arrhythmias should be treated with antiarrhythmic measures
Exam Question of:
  • 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 betablocker
  • Acute drug dystonia shows Abnormal movements like induced persistent deviation of neck on one side is seen with haloperiodol
  • 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

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