Haldol - FDA prescribing information, side effects and uses

Haloperidol

haldol im frequency

The decanoate ester of haloperidol haloperidol decanoate, trade names Haldol decanoate, Halomonth, Neoperidole has a much longer duration of action, so is often used in people known to be noncompliant with oral medication. Skin and Subcutaneous Tissue Disorders: Neither clinical studies nor epidemiologic studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive at this time. Pregnancy, Puerperium and Perinatal Conditions:

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For patients, particularly the elderly, with diseases, conditions, or medications that could exacerbate these effects, assess the risk of falls when initiating antipsychotic treatment and recurrently for patients receiving repeated doses. Janssen; [cited Sep 29]. In some cases, this condition may be permanent. Higher than recommended doses of any formulation and intravenous administration of Haldol appear to be associated with a higher risk of QT-prolongation and Torsades de Pointes. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS. It is not known whether gradual withdrawal of antipsychotic drugs will reduce the rate of occurrence of withdrawal emergent neurological signs but until further evidence becomes available, it seems reasonable to gradually withdraw use of Haldol see WARNINGS, Usage in Pregnancy.

Blood and Lymphatic System Disorders: Pancytopenia , Agranulocytosis ,. Thrombocytopenia, Leukopenia, Neutropenia Cardiac Disorders: Ventricular fibrillation , Torsade de pointes, Ventricular tachycardia , Extrasystoles. Inappropriate antidiuretic hormone secretion Gastrointestinal Disorders: Sudden death, Face edema, Edema, Hyperthermia , Hypothermia. Anaphylactic reaction, Hypersensitivity Investigations: Hypoglycemia Musculoskeletal and Connective Tissue Disorders: Rhabdomyolysis Nervous System Disorders: Convulsion , Headache, Opisthotonus, Tardive dystonia.

Pregnancy, Puerperium and Perinatal Conditions: Drug withdrawal syndrome neonatal. Respiratory, Thoracic and Mediastinal Disorders: Laryngeal edema, Bronchospasm, Laryngospasm, Dyspnea. Skin and Subcutaneous Tissue Disorders: Dermatitis exfoliative, Hypersensitivity vasculitis , Photosensitivity reaction, Urticaria , Pruritis, Rash, Hyperhidrosis. Drug-drug interactions can be pharmacodynamic combined pharmacologic effects or pharmacokinetic alteration of plasma levels.

The risks of using haloperidol in combination with other drugs have been evaluated as described below. Since QT-prolongation has been observed during HALDOL treatment, caution is advised when prescribing to a patient with QT-prolongation conditions long QT-syndrome, hypokalemia , electrolyte imbalance or to patients receiving medications known to prolong the QT-interval or known to cause electrolyte imbalance.

If concomitant antiparkinson medication is required, it may have to be continued after HALDOL is discontinued because of the difference in excretion rates. If both are discontinued simultaneously, extrapyramidal symptoms may occur.

The physician should keep in mind the possible increase in intraocular pressure when anticholinergic drugs, including antiparkinson agents, are administered concomitantly with HALDOL. Ketoconazole is a potent inhibitor of CYP3A4. It may be necessary to reduce the haloperidol dosage. Haloperidol is metabolized by several routes, including the glucuronidation and the cytochrome P enzyme system.

Inhibition of these routes of metabolism by another drug may result in increased haloperidol concentrations and potentially increase the risk of certain adverse events, including QT-prolongation. In pharmacokinetic studies, mild to moderately increased haloperidol concentrations have been reported when haloperidol was given concomitantly with drugs characterized as substrates or inhibitors of CYP3A4 or CYP2D6 isoenzymes, such as itraconazole, nefazodone, buspirone, venlafaxine , alprazolam , fluvoxamine, quinidine, fluoxetine , sertraline , chlorpromazine, and promethazine.

When prolonged treatment weeks with enzyme-inducing drugs such as rifampin or carbamazepine is added to HALDOL therapy, this results in a significant reduction of haloperidol plasma levels. In 5 other schizophrenic patients treated with haloperidol and rifampin, discontinuation of rifampin produced a mean 3.

In a study in 11 schizophrenic patients co-administered haloperidol and increasing doses of carbamazepine, haloperidol plasma concentrations decreased linearly with increasing carbamazepine concentrations.

Thus, careful monitoring of clinical status is warranted when enzyme inducing drugs such as rifampin or carbamazepine are administered or discontinued in haloperidol-treated patients. Sodium valproate, a drug know to inhibit glucuronidation, does not affect haloperidol plasma concentrations.

Although cases have been reported even in the absence of predisposing factors, particular caution is advised in treating patients with other QT-prolonging conditions including electrolyte imbalance [particularly hypokalemia and hypomagnesemia ], drugs known to prolong QT, underlying cardiac abnormalities, hypothyroidism , and familial long QT-syndrome.

Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown.

Both the risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses.

There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment, itself, however, may suppress or partially suppress the signs and symptoms of the syndrome and thereby may possibly mask the underlying process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown. Given these considerations, antipsychotic drugs should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia.

Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that, 1 is known to respond to antipsychotic drugs, and, 2 for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate.

In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically. If signs and symptoms of tardive dyskinesia appear in a patient on antipsychotics, drug discontinuation should be considered.

However, some patients may require treatment despite the presence of the syndrome. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status including catatonic signs and evidence of autonomic instability irregular pulse or blood pressure, tachycardia , diaphoresis, and cardiac dysrhythmias. Additional signs may include elevated creatine phosphokinase, myoglobinuria rhabdomyolysis and acute renal failure.

The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness e. Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke , drug fever and primary central nervous system CNS pathology.

The management of NMS should include 1 immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2 intensive symptomatic treatment and medical monitoring, and 3 treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.

If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported. Generally, patients receiving short-term therapy experience no problems with abrupt discontinuation of antipsychotic drugs. However, some patients on maintenance treatment experience transient dyskinetic signs after abrupt withdrawal.

Motor instability, somnolence , and orthostatic hypotension have been reported with the use of antipsychotics, including HALDOL, which may lead to falls and, consequently, fractures or other fall-related injuries.

For patients, particularly the elderly, with diseases, conditions, or medications that could exacerbate these effects, assess the risk of falls when initiating antipsychotic treatment and recurrently for patients receiving repeated doses. Rodents given 2 to 20 times the usual maximum human dose of haloperidol by oral or parenteral routes showed an increase in incidence of resorption , reduced fertility, delayed delivery and pup mortality. No teratogenic effect has been reported in rats, rabbits or dogs at dosages within this range, but cleft palate has been observed in mice given 15 times the usual maximum human dose.

Cleft palate in mice appears to be a nonspecific response to stress or nutritional imbalance as well as to a variety of drugs, and there is no evidence to relate this phenomenon to predictable human risk for most of these agents. There are reports, however, of cases of limb malformations observed following maternal use of HALDOL along with other drugs which have suspected teratogenic potential during the first trimester of pregnancy.

Causal relationships were not established in these cases. Since such experience does not exclude the possibility of fetal damage due to HALDOL,this drug should be used during pregnancy or in women likely to become pregnant only if the benefit clearly justifies a potential risk to the fetus. Infants should not be nursed during drug treatment. There have been reports of agitation, hypertonia , hypotonia , tremor , somnolence, respiratory distress, and feeding disorder in these neonates.

These complications have varied in severity; while in some cases symptoms have been self-limited, in other cases neonates have required intensive care unit support and prolonged hospitalization.

HALDOL should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. An encephalopathic syndrome characterized by weakness, lethargy , fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis , elevated serum enzymes, BUN , and fasting blood sugar followed by irreversible brain damage has occurred in a few patients treated with lithium plus HALDOL.

A causal relationship between these events and the concomitant administration of lithium and HALDOL 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. It has been postulated that lethargy and decreased sensation of thirst due to central inhibition may lead to dehydration, hemoconcentration and reduced pulmonary ventilation.

Therefore, if the above signs and symptoms appear, especially in the elderly, the physician should institute remedial therapy promptly. After discontinuation of such drugs, it may be necessary to reduce the dosage of Haldol. Sodium valproate, a drug know to inhibit glucuronidation, does not affect haloperidol plasma concentrations.

The ambulatory patient should be warned accordingly. The use of alcohol with this drug should be avoided due to possible additive effects and hypotension. No mutagenic potential of haloperidol was found in the Ames Salmonella microsomal activation assay.

Negative or inconsistent positive findings have been obtained in in vitro and in vivo studies of effects of haloperidol on chromosome structure and number. The available cytogenetic evidence is considered too inconsistent to be conclusive at this time. In the rat study survival was less than optimal in all dose groups, reducing the number of rats at risk for developing tumors. However, although a relatively greater number of rats survived to the end of the study in high-dose male and female groups, these animals did not have a greater incidence of tumors than control animals.

Therefore, although not optimal, this study does suggest the absence of a haloperidol related increase in the incidence of neoplasia in rats at doses up to 20 times the usual daily human dose for chronic or resistant patients. In female mice at 5 and 20 times the highest initial daily dose for chronic or resistant patients, there was a statistically significant increase in mammary gland neoplasia and total tumor incidence; at 20 times the same daily dose there was a statistically significant increase in pituitary gland neoplasia.

In male mice, no statistically significant differences in incidences of total tumors or specific tumor types were noted. Antipsychotic drugs elevate prolactin levels; the elevation persists during chronic administration. Tissue culture experiments indicate that approximately one-third of human breast cancers are prolactin dependent in vitro , a factor of potential importance if the prescription of these drugs is contemplated in a patient with a previously detected breast cancer.

Although disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported, the clinical significance of elevated serum prolactin levels is unknown for most patients. An increase in mammary neoplasms has been found in rodents after chronic administration of antipsychotic drugs. Neither clinical studies nor epidemiologic studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive at this time.

Since haloperidol is excreted in human breast milk, infants should not be nursed during drug treatment with haloperidol. Clinical studies of haloperidol did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Other reported clinical experience has not consistently identified differences in responses between the elderly and younger patients. The following adverse reactions are discussed in more detail in other sections of the labeling:. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug, and may not reflect the rates observed in practice.

Musculoskeletal and Connective Tissue Disorders: Torticollis, Trismus, Muscle rigidity, Muscle twitching. Reproductive System and Breast Disorders: The following adverse reactions relating to the active moiety haloperidol have been identified during postapproval use of haloperidol or haloperidol decanoate. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Blood and Lymphatic System Disorders: Pancytopenia, Agranulocytosis, Thrombocytopenia, Leukopenia, Neutropenia. Ventricular fibrillation, Torsade de pointes, Ventricular tachycardia, Extrasystoles. General Disorders and Administration Site Conditions: Sudden death, Face edema, Edema, Hyperthermia, Hypothermia.

Acute hepatic failure, Hepatitis, Cholestasis, Jaundice, Liver function test abnormal. Convulsion, Headache, Opisthotonus, Tardive dystonia. Pregnancy, Puerperium and Perinatal Conditions: Drug withdrawal syndrome neonatal. Agitation, Confusional state, Depression, Insomnia. Respiratory, Thoracic and Mediastinal Disorders: Laryngeal edema, Bronchospasm, Laryngospasm, Dyspnea. Skin and Subcutaneous Tissue Disorders: Dermatitis exfoliative, Hypersensitivity vasculitis, Photosensitivity reaction, Urticaria, Pruritis, Rash, Hyperhidrosis.

In general, the symptoms of overdosage would be an exaggeration of known pharmacologic effects and adverse reactions, the most prominent of which would be: The patient would appear comatose with respiratory depression and hypotension which could be severe enough to produce a shock-like state.

The extrapyramidal reactions would be manifested by muscular weakness or rigidity and a generalized or localized tremor as demonstrated by the akinetic or agitans types respectively. With accidental overdosage, hypertension rather than hypotension occurred in a two-year old child. The risk of ECG changes associated with torsade de pointes should be considered. Since there is no specific antidote, treatment is primarily supportive.

A patent airway must be established by use of an oropharyngeal airway or endotracheal tube or, in prolonged cases of coma, by tracheostomy. Respiratory depression may be counteracted by artificial respiration and mechanical respirators.

Hypotension and circulatory collapse may be counteracted by use of intravenous fluids, plasma, or concentrated albumin, and vasopressor agents such as metaraminol, phenylephrine and norepinephrine.

Epinephrine should not be used. In case of severe extrapyramidal reactions, antiparkinson medication should be administered. ECG and vital signs should be monitored especially for signs of Q-T prolongation or dysrhythmias and monitoring should continue until the ECG is normal. Severe arrhythmias should be treated with appropriate anti-arrhythmic measures. There is considerable variation from patient to patient in the amount of medication required for treatment.

As with all drugs used to treat schizophrenia, dosage should be individualized according to the needs and response of each patient. Dosage adjustments, either upward or downward, should be carried out as rapidly as practicable to achieve optimum therapeutic control.

To determine the initial dosage, consideration should be given to the patient's age, severity of illness, previous response to other antipsychotic drugs, and any concomitant medication or disease state.

Debilitated or geriatric patients, as well as those with a history of adverse reactions to antipsychotic drugs, may require less Haldol haloperidol. The optimal response in such patients is usually obtained with more gradual dosage adjustments and at lower dosage levels. Parenteral medication, administered intramuscularly in doses of 2 to 5 mg, is utilized for prompt control of the acutely agitated schizophrenic patient with moderately severe to very severe symptoms.

Depending on the response of the patient, subsequent doses may be given, administered as often as every hour, although 4 to 8 hour intervals may be satisfactory.

Controlled trials to establish the safety and effectiveness of intramuscular administration in children have not been conducted. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. An oral form should supplant the injectable as soon as practicable.

In the absence of bioavailability studies establishing bioequivalence between these two dosage forms the following guidelines for dosage are suggested. For an initial approximation of the total daily dose required, the parenteral dose administered in the preceding 24 hours may be used. Since this dose is only an initial estimate, it is recommended that careful monitoring of clinical signs and symptoms, including clinical efficacy, sedation, and adverse effects, be carried out periodically for the first several days following the initiation of switchover.

In this way, dosage adjustments, either upward or downward, can be quickly accomplished. Depending on the patient's clinical status, the first oral dose should be given within 12—24 hours following the last parenteral dose.

Usual Dosage For dosage and other prescribing information, see accompanying product literature. Dispense in a light- resistant container as defined in the official compendium. Haloperidol 5 mg as the lactate and lactic acid for pH adjustment to 3. Psychosis prochlorperazine , Compazine , haloperidol , chlorpromazine , perphenazine , fluphenazine , More The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records.

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Iamges: haldol im frequency

haldol im frequency

The ambulatory patient should be warned accordingly. Overdose If someone has overdosed and has serious symptoms such as passing out or trouble breathing , call Ventricular fibrillation , Torsade de pointes, Ventricular tachycardia , Extrasystoles.

haldol im frequency

Interactions Drug interactions may change how your medications work or increase your risk for serious side effects.

haldol im frequency

For Consumers What are the possible side effects haldol im frequency haloperidol Haldol? The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown. Rodents given 2 to 20 times the usual maximum human testosterone deficiency symptoms of haloperidol by oral or parenteral routes showed an increase in incidence of resorptionreduced fertility, delayed delivery and pup mortality. Neither clinical studies nor epidemiologic studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive at this hldol. This document does not contain all possible drug interactions. There is no known treatment for established haldol im frequency of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. A dose is given anabolic steroids winstrol side effects intramuscular injection once every two to four weeks.