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Patient Teaching Tool

Presented by Joseph A. Francisco for

NUR 641

Haloperidol (Haldol)

Haldol is a typical antipsychotic

Classification

It is the first of the butyrophenone series of major antipsychotics.

  • The chemical designation is 4-[4-(p-chlorophenyl)-4-hydroxypiperidino]-4’-fluorobutyrophenone.

Indications

On-label Uses

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

Strategy

Works as an antagonist of dopamine 2 (DA) receptors in the mesolimbic tract

Mechanism of Action

Reduces hyperactivity of the pathway

Antipsychotic effect

Adverse Effects

Extrapyramidal symptoms

Hyperprolactinemia

Increased negative symptoms

Anti-cholinergic effects

Neuroleptic malignant syndome

Adverse Effects

Extrapyramidal Symptoms

Extrapyramidal symptoms is characterized by

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)

Hyperprolactinemia is characterized by

Breast swelling

Impotence

Decreased sexual desire

Amenorrhea

Galactorrhea

Gynecomastia

Lowered sperm count

Feminization

Hyperprolactinemia

Negative symptoms are:

Apathy

Anhedonia

Lack of motivation, interest, and joy

Increased Negative Symptoms

Anti-cholinergic effects include:

Dry mouth

Blurred vision

Constipation

Cognitive blunting

Anti-cholinergic effecits

Neuroleptic Malignant Syndrome

Rare but fatal reaction and is characterized by:

  • Hyperthermia
  • Confusion
  • Agitation
  • Catatonia (rigidity)
  • Labile blood pressure
  • Sweating
  • Accelerated heart rate

Neuroleptic Malignant Syndrome

Who can use it?

Special population:

Pregnant women

Breastfeeding women

Pediatrics

Geriatrics

Use with caution as Haldol can result to withdrawal symptoms among newborns whose mothers were treated during their 3rd trimester

Pregnant women

Not to be taken by breastfeeding women as Haldol is excreted in the breast milk

Breastfeeding women

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

Pediatrics

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

Geriatrics

Although not approved by the FDA, Haldol is also used for:

Behavior management of elderly patients with dementia

Bipolar depression and mania

Generalized anxiety disorder

Obsessive-compulsive disorder

Acute delirium

Off-label Uses

Acute delirium is managed with Intravenous Haldol

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.

Friendly Reminders

Nurse practitioners should:

NPs Role in Off-label Prescribing

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

References

Thank you!

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