Haloperidol (Haldol) in the Treatment of Psychosis: Difference between revisions
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<div class="editorbox"> '''Original Editor '''- [[User:User Name|Mieka Bryan]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | |||
==== Introduction ==== | ==== Introduction ==== | ||
One of the most commonly used typical antipsychotic medications is Haloperidol (Haldol). Haldol’s primary purpose is for the treatment of symptoms associated with Schizophrenia. <ref name=":0">Ortho-McNeil Pharmaceutical, Inc. Haldol. 2005. <nowiki>https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/015923s082,018701s057lbl.pdf</nowiki>. Accessed September 5, 2018.</ref> Haldol has been shown to provide effective sedation to patients with acute schizophrenic episodes.<ref>Calver L, Drinkwater V, Gupta R, Page CB, Isbister GK. Droperidol v. haloperidol for sedation of aggressive behaviour in acute mental health: Randomised controlled trial. ''British Journal of Psychiatry''. 2015;206(03):223-228. doi:10.1192/bjp.bp.114.150227.</ref> The secondary purpose is for the control of tics and verbal utterances of Tourette’s disorder.<ref name=":0" /> | One of the most commonly used typical antipsychotic medications is Haloperidol (Haldol). Haldol’s primary purpose is for the treatment of symptoms associated with Schizophrenia. <ref name=":0">Ortho-McNeil Pharmaceutical, Inc. Haldol. 2005. <nowiki>https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/015923s082,018701s057lbl.pdf</nowiki>. Accessed September 5, 2018.</ref> Haldol has been shown to provide effective sedation to patients with acute schizophrenic episodes.<ref>Calver L, Drinkwater V, Gupta R, Page CB, Isbister GK. Droperidol v. haloperidol for sedation of aggressive behaviour in acute mental health: Randomised controlled trial. ''British Journal of Psychiatry''. 2015;206(03):223-228. doi:10.1192/bjp.bp.114.150227.</ref> The secondary purpose is for the control of tics and verbal utterances of Tourette’s disorder.<ref name=":0" /> | ||
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The active mechanism of Haldol is to block postsynaptic dopamine (D2) receptors in the mesolimbic system of the brain.<ref name=":0" /> | The active mechanism of Haldol is to block postsynaptic dopamine (D2) receptors in the mesolimbic system of the brain.<ref name=":0" /> | ||
==== | ==== Dosing ==== | ||
In the treatment of Schizophrenia and Tourette’s disorder, there are two methods of administration, oral and intramuscular (IM). With the treatment of moderate schizophrenia, the initial dose is commonly 0.5-2 mg every 12 hours. For severe schizophrenia, the dose is 3-5 mg every 12 hours without exceeding 30 mg per day.<ref name=":1">Haloperidol (Rx). Medscape Drugs & Diseases <nowiki>https://reference.medscape.com/drug/haldol-decanoate-haloperidol-342974</nowiki>. Published March 11, 2018. Accessed November 13, 2018.</ref> In the use of IM administration, the initial monthly dose is 10-20 times the daily oral dose without exceeding 100 mg. The maintenance dose is administered once a month, equaling to 10-15 times the daily oral dose.<ref name=":1" /> | In the treatment of Schizophrenia and Tourette’s disorder, there are two methods of administration, oral and intramuscular (IM). With the treatment of moderate schizophrenia, the initial dose is commonly 0.5-2 mg every 12 hours. For severe schizophrenia, the dose is 3-5 mg every 12 hours without exceeding 30 mg per day.<ref name=":1">Haloperidol (Rx). Medscape Drugs & Diseases <nowiki>https://reference.medscape.com/drug/haldol-decanoate-haloperidol-342974</nowiki>. Published March 11, 2018. Accessed November 13, 2018.</ref> In the use of IM administration, the initial monthly dose is 10-20 times the daily oral dose without exceeding 100 mg. The maintenance dose is administered once a month, equaling to 10-15 times the daily oral dose.<ref name=":1" /> | ||
In Tourette’s disorder, the initial oral dose is 0.5-2 mg every 8-12 hours. If the symptoms are severe, the dose increases to 3-5 mg every 8-12 hours. If the Tourette’s disorder is uncontrolled, the daily dose increases up to 100 mg daily.<ref name=":1" /> | In Tourette’s disorder, the initial oral dose is 0.5-2 mg every 8-12 hours. If the symptoms are severe, the dose increases to 3-5 mg every 8-12 hours. If the Tourette’s disorder is uncontrolled, the daily dose increases up to 100 mg daily.<ref name=":1" /> | ||
==== Pharmacokinetics ==== | |||
The pharmacokinetics of Haldol depend on patient characteristics such as gender, age, weight, and race. The half-life of Haldol is commonly 14.5-36.7 hours. The half-life for chronic administration is 21 days. The average clearance time for Haldol is approximately 24.2 mL/minute.<ref name=":2">LabCorp. LabCorp. <nowiki>https://www.labcorp.com/test-menu/26916/haloperidol-serum-or-plasma</nowiki>. Accessed November 13, 2018</ref> Haldol metabolizes in the liver by oxidizing N- dealkylation to piperidine metabolites and 4-fluorobenzoylpropionic acid.<ref name=":2" /> It is important for a physical therapist to understand the elimination rate of Haldol because it explains the prolonged effects of the drug and average timeline to monitor adverse effects. | The pharmacokinetics of Haldol depend on patient characteristics such as gender, age, weight, and race. The half-life of Haldol is commonly 14.5-36.7 hours. The half-life for chronic administration is 21 days. The average clearance time for Haldol is approximately 24.2 mL/minute.<ref name=":2">LabCorp. LabCorp. <nowiki>https://www.labcorp.com/test-menu/26916/haloperidol-serum-or-plasma</nowiki>. Accessed November 13, 2018</ref> Haldol metabolizes in the liver by oxidizing N- dealkylation to piperidine metabolites and 4-fluorobenzoylpropionic acid.<ref name=":2" /> It is important for a physical therapist to understand the elimination rate of Haldol because it explains the prolonged effects of the drug and average timeline to monitor adverse effects. | ||
==== | ==== Adverse Effects ==== | ||
In addition to the common adverse effects of typical antipsychotics, Haldol presents with withdrawal emergent neurological signs after discontinuation of the medication presented by dyskinetic movement distinguished by duration compared to tardive dyskinesia.<ref name=":0" /> Haldol’s contraindications is to refrain from use in patients with Parkinson’s, hypersensitivity to the drug, severe CNS depression or in a comatose state. | In addition to the common adverse effects of typical antipsychotics, Haldol presents with withdrawal emergent neurological signs after discontinuation of the medication presented by dyskinetic movement distinguished by duration compared to tardive dyskinesia.<ref name=":0" /> Haldol’s contraindications is to refrain from use in patients with Parkinson’s, hypersensitivity to the drug, severe CNS depression or in a comatose state. | ||
Physical Therapy Implications | ==== Physical Therapy Implications ==== | ||
Physical therapists should monitor vital signs during the session to better manage the potential for falls, unconsciousness, and hypotension. Physical therapists can develop interventions such as gait training and use of assistive devices for ambulatory issues.<ref name=":0" /> Physical therapists should monitor physiological changes in such as cardiovascular effects, tardive dyskinesia and neuroleptic malignant syndrome in elderly patients with dementia due to an increased mortality rate. <ref name=":0" /> | |||
For more information regarding Haldol, please visit the FDA's medication guide: [https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/015923s082,018701s057lbl.pdf Haldol] | |||
== Back to [ | == Back to [[Pharmacological treatment of Psychoses]] == | ||
<references /> | <references /> | ||
[[Category:Older People/Geriatrics]] | |||
[[Category:Pharmacological treatment of Psychoses]] | |||
[[Category:Mental Health - Interventions]] | |||
Latest revision as of 02:01, 6 April 2020
Introduction[edit | edit source]
One of the most commonly used typical antipsychotic medications is Haloperidol (Haldol). Haldol’s primary purpose is for the treatment of symptoms associated with Schizophrenia. [1] Haldol has been shown to provide effective sedation to patients with acute schizophrenic episodes.[2] The secondary purpose is for the control of tics and verbal utterances of Tourette’s disorder.[1]
Mechanism of Action[edit | edit source]
The active mechanism of Haldol is to block postsynaptic dopamine (D2) receptors in the mesolimbic system of the brain.[1]
Dosing[edit | edit source]
In the treatment of Schizophrenia and Tourette’s disorder, there are two methods of administration, oral and intramuscular (IM). With the treatment of moderate schizophrenia, the initial dose is commonly 0.5-2 mg every 12 hours. For severe schizophrenia, the dose is 3-5 mg every 12 hours without exceeding 30 mg per day.[3] In the use of IM administration, the initial monthly dose is 10-20 times the daily oral dose without exceeding 100 mg. The maintenance dose is administered once a month, equaling to 10-15 times the daily oral dose.[3]
In Tourette’s disorder, the initial oral dose is 0.5-2 mg every 8-12 hours. If the symptoms are severe, the dose increases to 3-5 mg every 8-12 hours. If the Tourette’s disorder is uncontrolled, the daily dose increases up to 100 mg daily.[3]
Pharmacokinetics[edit | edit source]
The pharmacokinetics of Haldol depend on patient characteristics such as gender, age, weight, and race. The half-life of Haldol is commonly 14.5-36.7 hours. The half-life for chronic administration is 21 days. The average clearance time for Haldol is approximately 24.2 mL/minute.[4] Haldol metabolizes in the liver by oxidizing N- dealkylation to piperidine metabolites and 4-fluorobenzoylpropionic acid.[4] It is important for a physical therapist to understand the elimination rate of Haldol because it explains the prolonged effects of the drug and average timeline to monitor adverse effects.
Adverse Effects[edit | edit source]
In addition to the common adverse effects of typical antipsychotics, Haldol presents with withdrawal emergent neurological signs after discontinuation of the medication presented by dyskinetic movement distinguished by duration compared to tardive dyskinesia.[1] Haldol’s contraindications is to refrain from use in patients with Parkinson’s, hypersensitivity to the drug, severe CNS depression or in a comatose state.
Physical Therapy Implications[edit | edit source]
Physical therapists should monitor vital signs during the session to better manage the potential for falls, unconsciousness, and hypotension. Physical therapists can develop interventions such as gait training and use of assistive devices for ambulatory issues.[1] Physical therapists should monitor physiological changes in such as cardiovascular effects, tardive dyskinesia and neuroleptic malignant syndrome in elderly patients with dementia due to an increased mortality rate. [1]
For more information regarding Haldol, please visit the FDA's medication guide: Haldol
Back to Pharmacological treatment of Psychoses[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Ortho-McNeil Pharmaceutical, Inc. Haldol. 2005. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/015923s082,018701s057lbl.pdf. Accessed September 5, 2018.
- ↑ Calver L, Drinkwater V, Gupta R, Page CB, Isbister GK. Droperidol v. haloperidol for sedation of aggressive behaviour in acute mental health: Randomised controlled trial. British Journal of Psychiatry. 2015;206(03):223-228. doi:10.1192/bjp.bp.114.150227.
- ↑ 3.0 3.1 3.2 Haloperidol (Rx). Medscape Drugs & Diseases https://reference.medscape.com/drug/haldol-decanoate-haloperidol-342974. Published March 11, 2018. Accessed November 13, 2018.
- ↑ 4.0 4.1 LabCorp. LabCorp. https://www.labcorp.com/test-menu/26916/haloperidol-serum-or-plasma. Accessed November 13, 2018
