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Haloperidol (Haldol)
It is the first of the butyrophenone series of major antipsychotics.
Psychotic disorders such schizophrenia and delusional disorders
Motor and verbal tics in adults and children who have Tourette's disorder
Severe behavioral problems in children who cannot be treated with psychotherapy or with other medications
Confusion and difficulty in thinking secondary to severe physical or mental illness
Works as an antagonist of dopamine 2 (DA) receptors in the mesolimbic tract
Reduces hyperactivity of the pathway
Antipsychotic effect
Adverse Effects
Extrapyramidal symptoms
Hyperprolactinemia
Increased negative symptoms
Anti-cholinergic effects
Neuroleptic malignant syndome
Akathisia (restlessness)
Akinesia (Parkinson-like stiffness and lack of movement)
Dyskinesia (Parkinson-like tremors), Dystonia (muscle spasm)
Tardive dyskinesia (abnormal movements of the mouth and face)
Breast swelling
Impotence
Decreased sexual desire
Amenorrhea
Galactorrhea
Gynecomastia
Lowered sperm count
Feminization
Hyperprolactinemia
Apathy
Anhedonia
Lack of motivation, interest, and joy
Dry mouth
Blurred vision
Constipation
Cognitive blunting
Rare but fatal reaction and is characterized by:
Special population:
Pregnant women
Breastfeeding women
Pediatrics
Geriatrics
Not to be taken by breastfeeding women as Haldol is excreted in the breast milk
Results to increased extrapyramidal symptoms in children; thus, limit use on as needed, short-term basis, or to young patients who are non-responsive or intolerable to novel agents
Results to increased risks for fall, fall-related injuires, and increased mortality among the elderly; thus, Haldol use should be limited on as needed, short-term basis, or older patients who are non-responsive or intolerable to novel agents
Behavior management of elderly patients with dementia
Bipolar depression and mania
Generalized anxiety disorder
Obsessive-compulsive disorder
Acute delirium
Electrocardiogram monitoring is a must for this off-label use as patients who are receiving IV haloperidol are at increased risk of QT prolongation, torsades and/or cardiac arres
Although off-label prescribing is not considered as a malpractice, it is not without legal risk.
Thus, it is recommended that a rationale for the off-label use be well documented.
Document prior attempts to use standard treatment
Notify the patient/caregiver that the medication is of off-label use
Inform the patient/caregiver of the adverse effects of haloperidol
Discuss with the patient/caregiver how the use of this drug will benefit the patient and outweigh the risks
Cheung, D., Wolfe, B., Wald, H., & Cumbler, E. (2013). Unsafe Use of Intravenous Haloperidol: Evaluation of Recommendation‐Concordant Care in Hospitalized Elderly Adults. Journal of the American Geriatric Society, 61(1), 160-161. https://doi-org.libproxy.chapman.edu/10.1111/jgs.12049
Drugs to treat anxiety disorders. (2016). Journal of Psychosocial Nursing & Mental Health Services, 54(5), 19-20. doi:http://dx.doi.org.libproxy.chapman.edu/10.3928/02793695-20160330-79
Drugs to treat bipolar disorders. (2016). Journal of Psychosocial Nursing & Mental Health Services, 54(6), 19-20. doi:http://dx.doi.org.libproxy.chapman.edu/10.3928/02793695-20160428-79
Food and Drugs Authority (2011). FDA Drug Safety Communication: Antipsychotic drug labels updated on use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns. Retrieved from https://www.fda.gov/Drugs/DrugSafety/ucm243903.htm
Food and Drugs Authority (2017a). Haldol: Brand of haloperidol injection (for immediate release). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018701s070lbl.pdf
de Oliveira, A.S., de Oliveira, L.M., Wagner, L.C., Ferrao, Y.A., & Martins, C. (2011). The impact of the use of antipsychotics in musculoskeletal function in schizophrenic patients [Abstract]. Revista Terapia Manual, 9(41), 36-44. Retrieved from http://eds.a.ebscohost.com.libproxy.chapman.edu
James, R. & Candi, H. (2014). Off-label use of antipsychotic drugs in patients with dementia. The Journal for Nurse Practitioners, 10(3), 200-204. doi:http://dx.doi.org.libproxy.chapman.edu/10.1016/j.nurpra.2013.11.017
MedlinePlus (2017). Haloperidol. Retrieved from https://medlineplus.gov/druginfo/meds/a682180.html
Melillo, K.D. & Houde, S.C. (2011). Geropsychiatric and Mental Health Nursing, (2nd ed.). Sudbury, MA: Jones & Bartlett Learning
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York: Cambridge University Press.
Tusaie, K. & Fitzpatrick, J. (2013). Advanced Practice Psychiatric Nursing: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches. New York, NY: Springer Publishing Company, LLC.
Yoo, H.K., Lee, J.S., Paik, K.W., Choi, S.H., Yoon, S., Kim, J.E., & Hong, J.P. (2011). Open-label study comparing the efficacy and tolerability of aripiprazole and haloperidol in the treatment of pediatric tic disorders. European Child & Adolescent Psychiatry, 20(3), 127-135. DOI:10.1007/s00787-010-0154-0
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