Presentation
This work shows that high levels of the glucuronidated form of haloperidol are present in patient urine samples. [ncbi.nlm.nih.gov]
Diagnosis and treatment of newly presenting delirium in elderly people can be challenging as it is often multifactorial. Clinical guidance recommends that patients are reviewed, and screening tools used. [gov.uk]
B’s case illustrates the classical delirium presentation ( Table 1 ), 6 highlighting 2 hallmark features of the disorder: inattention and an acute fluctuating course. 4 Unfortunately, delirium is a diverse disorder that may present with numerous nonclassical [mdedge.com]
When it is administered as an intramuscular depot injection in sesame oil, esterases present in the blood and tissues hydrolyse haloperidol decanoate to provide a slow release of the active neuroleptic haloperidol from the depot into the systemic circulation [myvmc.com]
Contraindications: Haloperidol should not be used in cases where other drug, especially sedatives are present. [mstcparamedic.pbworks.com]
Respiratoric
- Pneumonia
Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. [sagentpharma.com]
subcortical brain damage, or cardiac disease; if history of seizures, benefits must outweigh risks; significant increase in body temperature may indicate intolerance to antipsychotics (discontinue if this occurs) Use caution in patients at risk of pneumonia [reference.medscape.com]
[…] related psychosis who are treated with antipsychotic drugs are at an increased risk for death, as shown in short-term controlled trials; deaths in trials appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia [rxlist.com]
[…] infant withdrawal symptoms 1 study on Haldol causing brain shrinkage or other structural brain changes 1 study on Haldol causing lack of efficacy 1 study on Haldol causing blood pressure changes or high or low blood pressure 1 study on Haldol causing pneumonia [cchrint.org]
Gastrointestinal
- Vomiting
Secondary outcomes included the number of vomiting episodes and side effects over time. [ncbi.nlm.nih.gov]
The vomiting centre is responsible for causing feelings of sickness (nausea) and for the vomiting reflex. [netdoctor.co.uk]
Background: Nausea and vomiting are common symptoms in patients with terminal, incurable illnesses. Both nausea and vomiting can be distressing. Haloperidol is commonly prescribed to relieve these symptoms. [cochrane.org]
- Nausea
OBJECTIVES: To determine any difference in the effectiveness of ABH gel compared with placebo in cancer patients with nausea. [ncbi.nlm.nih.gov]
Background: Nausea and vomiting are common symptoms in patients with terminal, incurable illnesses. Both nausea and vomiting can be distressing. Haloperidol is commonly prescribed to relieve these symptoms. [cochrane.org]
Haloperidol controls nausea and vomiting by blocking dopamine receptors found in the CTZ. This stops the CTZ from sending the messages to the vomiting centre that would otherwise cause nausea and vomiting. [netdoctor.co.uk]
Jaw & Teeth
- Xerostomia
[…] anticoagulants; isolated instance of interference occurred with effects of one anticoagulant (phenindione) When used to control mania in cyclic disorders, there may be rapid mood swing to depression May cause anticholinergic effects; use caution in patients with xerostomia [reference.medscape.com]
Adverse anticholinergic effects of haloperidol include dry mouth (xerostomia), blurred vision, constipation, urinary retention, and diaphoresis. Priapism has also occurred. [endoflifecare.tripod.com]
Because molindone shares certain pharmacological properties with other antipsychotics, additive cardiac effects (e.g., hypotension), CNS effects (e.g., drowsiness), or anticholinergic effects (e.g., constipation, xerostomia) may occur. [pdr.net]
Liver, Gall & Pancreas
- Jaundice
Jaundice associated with haloperidol. Lancet 1963; 2: 890-1. [livertox.nih.gov]
• Liver : Impaired liver function and/or jaundice. • Skin : Pimples, photosensitivity and loss of hair. • Genitourinary : Spontaneous milk secretion, breast engorgement, menstrual irregularities, breast enlargement in male, impotence, increased sexual [medindia.net]
[…] or lack of sweating Increased blinking or eyelid spasms Muscle weakness Sore throat and fever Uncontrolled twisting movements of neck, trunk, arms or legs Unusual bleeding or bruising Unusual facial expressions or body positions Yellow eyes or skin (jaundice [verywellmind.com]
Extrapyramidal symptomsExtremely high fever Eye problems Fast or irregular heartbeat Fine, worm-like tongue movements Grand mal seizures/Seizures Hallucinations Heat stroke High or low blood pressure Increased saliva Inflammation of the lungs Insomnia Jaundice [cchrint.org]
Cardiovascular
- Orthostatic Hypotension
Orthostatic hypotension may been seen in conjunction with this med, for this reason care should be given when administering this med to patient's taking anticoagulants. [mstcparamedic.pbworks.com]
Orthostatic hypotension causes patients to become dizzy upon arising from a lying or sitting position because of a drop in blood pressure. [medicinenet.com]
[…] evidence becomes available, gradually withdraw therapy Hyperprolactinemia may occur Monitor for mental status changes, muscle rigidity, fever, and/or autonomic instability; neuroleptic malignant syndrome may occur Motor instability, somnolence, and orthostatic [reference.medscape.com]
Therefore, they have a greater propensity to cause sedation and orthostatic hypotension. Pharmacokinetics. Haloperidol is well absorbed from the GI tract and by the intramuscular route. [accessmedicine.mhmedical.com]
Eyes
- Blurred Vision
Adverse reactions due to haloperidol intoxication include drowsiness, blurred vision, extrapyramidal effects, tardive dyskinesia, tachycardia, hypotension and muscular rigidity. [ncbi.nlm.nih.gov]
See physician if severe: Lethargy / sleepiness,dry mouth, blurred vision, constipation, or weight gain. See physician NOW: Reduced urinary output. [psyweb.com]
Additional information Common side effects of Haldol include dry mouth, blurred vision, diarrhea, loss of appetite, agitation, heartburn, nausea, and headaches. [huntingtonsdiseasenews.com]
Adverse effects may include drowsiness, blurred vision, tardive dyskinesia, tachycardia, nausea and vomiting. [ltd.aruplab.com]
• It may cause drowsiness, dizziness or blurred vision, do not drive a car or operate machinery while taking this medication. • Avoid exposure to sunlight; otherwise it may cause sunburn easily. • Avoid becoming overheated; otherwise heatstroke may [medindia.net]
- Visual Impairment
Closed-angle glaucoma, increased intraocular pressure, visual disturbance Evaluate patients who complain of unusual visual disturbance. [pdr.net]
Musculoskeletal
- Torticollis
Acute dystonia can be painful and dramatic, including torticollis, retrocollis, oculogyric crisis, and opisthotonos. Laryngeal dystonia may lead to severe respiratory distress, stridor, dysphagia and dysphonia, which can be mistaken as anaphylaxis. [sinaiem.org]
Delayed onset of oculogyric crisis and torticollis with intramuscular haloperidol. Ann Pharmacother. 2003;37(10):1434-1437. 8. Adams CE et al. Haloperidol versus placebo for schizophrenia. Cochrane Database Syst Rev. 2013. 15;(11):CD003082. 9. [psychiatryadvisor.com]
[…] comparator-controlled clinical trials with the injectable or oral formulation, or at Cardiac Disorders: Tachycardia Endocrine Disorders: Hyperprolactinemia Eye Disorders: Vision blurred Investigations: Weight increased Musculoskeletal and Connective Tissue Disorders: Torticollis [rxlist.com]
- Fracture
[…] may occur Monitor for mental status changes, muscle rigidity, fever, and/or autonomic instability; neuroleptic malignant syndrome may occur Motor instability, somnolence, and orthostatic hypotension reported, which may lead to falls and, consequently, fractures [reference.medscape.com]
[…] on Haldol causing blood pressure changes or high or low blood pressure 2 warnings on Haldol causing newborn complications (including infant withdrawal symptoms) 2 warnings on Haldol causing nervous system disorders 1 warning on Haldol causing risk of fractures [cchrint.org]
Dizziness or severe drowsiness can cause falls, fractures, or other injuries. Haloperidol side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. [drugs.com]
This medicine may cause some people to become dizzy, drowsy, or may cause trouble with thinking or controlling body movements, which may lead to falls, fractures or other injuries. [mayoclinic.org]
- Motor Restlessness
These include dystonia (continuous, often painful muscle spasms and contractions) and akathisia (motor restlessness). These reactions can be treated with anticholinergics like benzotropine or diphenhydramine. [epmonthly.com]
Other adverse neuromuscular reactions have been reported less frequently, but are often more severe, and include feelings of motor restlessness (i.e., akathisia), tardive dystonia, and dystonic reactions (e.g., hyperreflexia, opisthotonos, oculogyric [endoflifecare.tripod.com]
Psychiatrical
- Aggressive Behavior
Behavior|Ketamine David Barbic|St Paul''s Emergency Department Research Fund|Centre for Health Evaluation and Outcome Sciences (CHÉOS)|University of British Columbia May 29 2018 Phase 2 NCT03628391 Recruiting Delirium|Critical Illness|Intensive Care [selleckchem.com]
Screaming for three to four hours, aggressive behaviors, delusions, incoherent babble, sweating, hyperventilating, involuntary mandibular movements and teeth crashing. Hospice came in and the doctor prescribed Haldol. [lbda.org]
Haloperidol is also used to treat severe behavioral problems such as explosive, aggressive behavior or hyperactivity in children who cannot be treated with psychotherapy or with other medications. [nlm.nih.gov]
Haloperidol should be reserved for these two groups of children only after failure to respond to psychotherapy or medications other than antipsychotics. 15 Associated Conditions Aggressive Behavior Chemotherapy-Induced Nausea and Vomiting (CINV) Delirium [drugbank.ca]
Neurologic
- Agitation
It is the drug of choice in hospice for the treatment of terminal agitation and delirium. Haldol ( also known as haloperidol ) is an antipsychotic medication. In hospice, it is used to treat terminal delirium, severe agitation in end-stage dementia. [crossroadshospice.com]
Even within a unique setting with high-powered and board-spectrum therapeutic tools, acute agitation can pose a serious problem. [ncbi.nlm.nih.gov]
[…] sort of agitation. [nrsng.com]
A fourth study reviewed several previously research studies that had been conducted on the use of medications to treat agitation in dementia. [verywellhealth.com]
- Seizure
Administration: IV Infusion: 100 mg in 100 ml of dextrose 5% (maximum concentration of 3 mg/ml) Adverse Effects: tachycardia hypotension or hypertension CNS: ataxia, fixed stare, tardive dyskinesia, tardive dystonia, insomnia, restlessness, agitation, seizures [lhsc.on.ca]
• Caution should be exercised in patients with history of blood disease porphyria, decrease in white blood cells, electrolyte disturbances, high or low blood pressure, dementia, Alzheimer’s disease, seizures, abnormal electroencephalogram (EEG), thyroid [medindia.net]
Therefore, before using haloperidol, report all medications you are currently using to your doctor or pharmacist.Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with haloperidol such as: isoniazid [medicinenet.com]
- Akathisia
Treatment of Akathisia Akathisia refers to an uncomfortable sense of internal restlessness, accompanied by constant movement of the legs or pacing back and forth. [livestrong.com]
Haloperidol ( Symptoms or Effects ) Common: Akathisia, akinesia,lethargy / sleepiness, low blood pressure, dry mouth, blurred vision, constipation, weight gain, difficulty urinating, or stiffness ( Acute dystonia ). [psyweb.com]
Haloperidol: Adverse Reactions Even in therapeutic doses, haloperidol commonly causes extrapyramidal movement disorders, especially parkinsonism, acute dyskinesias, and akathisia (motorial excitation). [infomed.ch]
- Insomnia
[…] bolus prn up to every 30-60 minutes Administration: IV Infusion: 100 mg in 100 ml of dextrose 5% (maximum concentration of 3 mg/ml) Adverse Effects: tachycardia hypotension or hypertension CNS: ataxia, fixed stare, tardive dyskinesia, tardive dystonia, insomnia [lhsc.on.ca]
Common side effects of Haldol include: nausea, vomiting, diarrhea, dry mouth, nervousness, headache, dizziness, spinning sensation, drowsiness, sleep problems (insomnia), restlessness, anxiety, skin rash, itching, spontaneous eye movements, mood changes [rxlist.com]
Side Effects: Insomnia Restlessness Drowsiness Seizures Respiratory Depression Dry Mouth Constipation Hypotentsion Tachycardia Extrapyramidal symptoms Interactions: Antihypertensive medications may increase the likelihood of patient's developing hypotension [mstcparamedic.pbworks.com]
Other important side effects are: sedation, weight gain, erectile dysfunction, menstrual irregularities, insomnia, gynecomastia, dry mouth, vomiting, and constipation Haldol may cause a condition called " orthostatic hypotension " during the early phase [medicinenet.com]
- Stupor
indigestion, involuntary movements, irregular menstrual periods, irregular pulse, lack of muscular coordination, liver problems, loss of appetite, muscle spasms, nausea, Parkinson-like symptoms, persistent abnormal erections, physical rigidity and stupor [healthyplace.com]
A high value (greater than 50 ng/mL) for the test may indicate haloperidol toxicity, which is marked by: Vomiting Elevated blood pressure Loss of consciousness Seizures Stupor Nausea Anxiety A low value (less than 3 ng/mL) for the test may indicate more [dovemed.com]
Although most patients recover fully, delirium may progress to stupor, coma, seizures, and death, particularly if untreated. [endoflifecare.tripod.com]
Workup
We perform a delirium workup while we start Ms. B on olanzapine, 5 mg/d orally and 5 mg intramuscular (IM) every 8 hours as needed. Ms. [mdedge.com]
Case 2 A 28-year-old man also with recurrent CHS and multiple ED visits and nondiagnostic workups came to the ED requesting admission to the hospital. This patient also had no other history of psychiatric disorder. [journals.lww.com]
Serum
- Hypoglycemia
Additive anticholinergic effects, possible hypoglycemia. propofol propofol and haloperidol both increase sedation. [reference.medscape.com]
Endocrine: Menstrual irregularities, galactorrhea, lactation, gynecomastia, impotence, increased libido, hyponatremia, hyperglycemia, hypoglycemia. Special Senses: Blurred vision. Hematologic: Mild transient leukopenia, agranulocytosis (rare). [robholland.com]
Acute hepatic failure, Hepatitis, Cholestasis, Jaundice, Liver function test abnormal Immune System Disorders: Anaphylactic reaction, Hypersensitivity Investigations: Electrocardiogram QT prolonged, Weight decreased Metabolic and Nutritional Disorders: Hypoglycemia [rxlist.com]
[…] sweat, muscle weakness, and/or confusion. [ Ref ] Metabolic Hyperammonemia occurred in a pediatric patient with citrullinemia (inherited disorder of ammonia excretion). [ Ref ] Common (1% to 10%): Weight increased/decreased Frequency not reported : Hypoglycemia [drugs.com]
Endocrine Disorders Lactation, breast engorgement, mastalgia, menstrual irregularities, gynecomastia, impotence, increased libido, hyperglycemia, hypoglycemia and hyponatremia Label Gastrointestinal Effects Anorexia, constipation, diarrhea, hypersalivation [drugbank.ca]
- Hyperprolactinemia
Anticholinergic effects (e.g. dry mouth), consequences of hyperprolactinemia (menstruation disorders, galactorrhea, impotence), seborrheic dermatitis and gastrointestinal ailments have been observed. [infomed.ch]
[…] are indistinguishable from tardive dyskinesia except for duration; not known whether gradual withdrawal will reduce rate of occurrence of withdrawal emergent neurological signs but until further evidence becomes available, gradually withdraw therapy Hyperprolactinemia [reference.medscape.com]
Additional adverse reactions that are listed below were reported by haloperidol-treated patients in double-blind, active comparator-controlled clinical trials with the injectable or oral formulation, or at Cardiac Disorders: Tachycardia Endocrine Disorders: Hyperprolactinemia [rxlist.com]
[…] lymphomonocytosis [ Ref ] Hypersensitivity Uncommon (0.1% to 1%): Hypersensitivity reactions Frequency not reported : Anaphylactic reaction [ Ref ] Endocrine Inappropriate antidiuretic hormone secretion occurred with hyponatremia [ Ref ] Rare (0.01% to 0.1%): Hyperprolactinemia [drugs.com]
- Hyponatremia
[…] anemia, lymphocytosis, monocytosis, lymphomonocytosis [ Ref ] Hypersensitivity Uncommon (0.1% to 1%): Hypersensitivity reactions Frequency not reported : Anaphylactic reaction [ Ref ] Endocrine Inappropriate antidiuretic hormone secretion occurred with hyponatremia [drugs.com]
Endocrine: Menstrual irregularities, galactorrhea, lactation, gynecomastia, impotence, increased libido, hyponatremia, hyperglycemia, hypoglycemia. Special Senses: Blurred vision. Hematologic: Mild transient leukopenia, agranulocytosis (rare). [robholland.com]
Endocrine Disorders Lactation, breast engorgement, mastalgia, menstrual irregularities, gynecomastia, impotence, increased libido, hyperglycemia, hypoglycemia and hyponatremia Label Gastrointestinal Effects Anorexia, constipation, diarrhea, hypersalivation [drugbank.ca]
Galactorrhea, mastalgia, gynecomastia, increased libido, impotence, hyperglycemia, hypoglycemia, and hyponatremia have also occurred in some patients. Antipsychotic agents increase serum prolactin concentrations. (See Cautions: Carcinogenicity.) [endoflifecare.tripod.com]
Rhythm
- Torsades De Pointes
Disopyramide administration is associated with QT prolongation and torsades de pointes (TdP). QT prolongation and torsade de pointes (TdP) have been observed during haloperidol treatment. [pdr.net]
Administration • Be aware that torsades de pointes and QT interval prolongation have occurred in patients receiving haloperidol, especially when drug is given I.V. or in doses higher than recommended. [medical-dictionary.thefreedictionary.com]
This advisory addresses the risk of QT prolongation and Torsades de Pointes (TdP) in patients treated with haloperidol (a butryphenone antipsychotic ), especially when given intravenously. [psychcentral.com]
Treatment
The need for further ECGs during treatment should be assessed on an individual basis, and blood pressure monitoring during treatment is also advised. [gov.uk]
[…] to more than one-half of their chronic refractory patients showed remarkable improvement with a partial multimodal treatment. [ncbi.nlm.nih.gov]
In adults, for: treatment of schizophrenia and schizoaffective disorder; acute treatment of delirium when non-pharmacological treatments (treatments that do not involve medicines) have not worked; treatment of moderate to severe manic episodes associated [ema.europa.eu]
According to "Kaplan and Sadock's Textbook of Psychiatry," there is no effective treatment. [livestrong.com]
Prognosis
We additionally adjusted for number of days from admission to the day before index date, as a longer hospital stay is associated with a worse prognosis. 29 30 Statistical analyses We compared the baseline characteristics of the patients who initiated [bmj.com]
Etiology
Regardless of the etiology, all types of delirium share a set of common symptoms that include: Disturbances of consciousness and attention Changes in cognition such as memory deficit, language disturbance, or disorientation Perceptual disturbances not [mdedge.com]
Both samples did not significantly differ in respect to age, cancer diagnoses or etiologies. The MDAS scores at baseline were higher in HAL treated subjects (20.2) compared to RIS treated subjects (17.7). [scielo.isciii.es]
The choice of somatic intervention will depend on the specific features of the patients clinical condition, the underlying etiology of the delirium, and any associated comorbid conditions. [endoflifecare.tripod.com]
Epidemiology
^ "Pinkbook | Vaccine Administration | Epidemiology of VPDs | CDC". www.cdc.gov. 2017-10-04. Retrieved 2017-10-30. ^ "What Is a Subcutaneous Injection?". Healthline. Retrieved 2017-11-15. ^ "Administer the Vaccine(s)". www.cdc.gov. 2017-09-01. [en.wikipedia.org]
Epidemiology Although widely used as an antipsychotic, acute poisoning with haloperidol is rare. Adverse effects Extrapyramidal effects such as acute dystonia, Parkinsonian rigidity, tremor, and akathisia. [inchem.org]
[…] programmer 1, Krista F Huybrechts, assistant professor 1 1 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont Street, Boston, MA, 02120, USA 2 Department of Epidemiology [bmj.com]
Although an increase in mammary neoplasms has been found in rodents following long-term administration of prolactin-stimulating antipsychotic agents, no clinical or epidemiologic studies conducted to date have shown an association between long-term administration [endoflifecare.tripod.com]
Pathophysiology
Useful For Suggests clinical disorders or settings where the test may be helpful Optimizing dosage Monitoring compliance Assessing toxicity Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory [mayomedicallaboratories.com]
Cannabinoid hyperemesis and compulsive bathing: a case series and paradoxical pathophysiological explanation. J Am Board Fam Med. 2010;23:90–93. 13. Morris R, Fisher M. Cannabinoid hyperemesis syndrome : a specific cause of cyclical vomiting. [journals.lww.com]
Prevention
[…] levodopa; Medicines used to treat epilepsy (such as carbamazapine, phenobarbital); Medicines used to slow or prevent blood clotting (anticoagulants). [myvmc.com]
This security monitor is set up to prevent malicious bots and malware from accessing the site. [askapatient.com]
The use of agents given via inappropriate routes may delay or prevent the use of more effective interventions. [aafp.org]
The CMI and the CMI Search are not intended to be used by consumers to diagnose, treat, cure or prevent any disease or for any therapeutic purpose. [mydr.com.au]
[…] levodopa (Levodopa) medicines used to treat epilepsy (such as carbamazapine, phenobarbital) medicines used to slow or prevent blood clotting (anticoagulants). [nps.org.au]