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haloperidol

haloperidol

introduction

  • droperidol is a butyrophenone type antipsychotic agent which is similar to droperidol (Droleptan)
  • it produces marked tranquillization and sedation as well as having an anti-emetic effect
  • it potentiates other CNS depressants
  • also produces mild alpha-adrenergic blockade, peripheral vascular dilatation, hypotension, and reduction of the pressor effect of adrenaline
  • as with all drugs, benefits of using haloperidol should be weighed against the potential risk

C/I

precautions

  • FH sudden death
  • PH cardiac disease
  • liver impairment
  • chronic obstructive pulmonary disease (COPD) or significant respiratory disease
  • patients at risk of electrolyte disturbances such as those on diuretics
  • ensure cardiac monitoring and resuscitation facilities are nearby in case the low risk of torsade de pointes VT eventuates, or the patient has a respiratory arrest (more likely to occur withconcurrent sedatives such as opiates and opioids, particularly if these are given rapidly iv)
  • reduce initial doses of concurrent opiates and opioids to 1/3rd of normal doses
  • pregnancy in 3rd trimester as risk of neonatal extrapyramidal effects
  • lactation
  • safety not established in children under 2yrs
  • no use of machinery or driving within 24hrs of dose if dose > 5mg (10hrs for 5mg doses)
  • elderly
  • glaucoma patients
  • patients at risk of urinary retention
  • bipolar disorder as rapid change to depressed state may occur

P/K

  • rapidly absorbed from the gastrointestinal tract following oral administration but appears to undergo first-pass metabolism in the liver
  • peak plasma levels within 2-6 hours of oral dosing and ~20 minutes after im administration
  • onset of action is 3-10 minutes following intravenous or intramuscular administration, although maximum effect may be delayed until 30 minutes
  • plasma half life 12-28hrs

adverse effects

dose for Mx of severe agitation in ED

  • healthy adults excluding the elderly:
    • 2-10mg im or slow iv
    • titrated slow iv boluses may be used every 30-60 minutes up to max. 100mg in 24hrs
    • ongoing maintenance dose usually at half the total daily dose required to gain control, and gioven at least 4-8hrs after the last controlling dose

oral doses

  • usual dose is 1-5mg per day (1-3mg in the elderly)
  • those with severe symptoms may require 5-15mg/day and titrated (max. 100mg/day)
  • NB. risk of irreversible tardive dyskinesia with long term dosing
haloperidol.txt · Last modified: 2014/05/05 17:00 (external edit)