Haloperidol decanoate

dr.joandr.joan عضو ماسي
تم تعديل 2009/06/28 في أدوية الطوارئ Emergency drugs
Haloperidol decanoate :
Trade name: Apo-Haloperidol, Haldol, Haldol Decanoate, Haldol, Novo-Peridol, Peridol, PMS-Haloperidol.
Drug classes
· Dopaminergic blocking drug
· Antipsychotic drug
· Butyrophenone (not a phenothiazine)
Pregnancy: (Category C)

Action:
Mechanism not fully understood: antipsychotic drugs block postsynaptic dopamine receptors in the brain, depress the RAS, including those parts of the brain involved with wakefulness and emesis; chemically resembles the phenothiazines.
Indications
· Management of manifestations of psychotic disorders
· Control of tics and vocalizations in Gilles de la Tourette's syndrome in adults and children
· Short-term treatment of hyperactive children who also show impulsivity, difficulty sustaining attention, aggressivity, mood lability, or poor frustration tolerance
· Prolonged parenteral therapy of chronic schizophrenia (haloperidol decanoate)
· Unlabeled uses: control of nausea and vomiting, control of acute psychiatric situations (IV use)
Contraindications/cautions
  • Contraindications: coma or severe CNS depression, bone marrow depression, blood dyscrasia, circulatory collapse, subcortical brain damage, Parkinson's disease, liver damage, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension.
  • Use cautiously with respiratory disorders ("silent pneumonia"); glaucoma, prostatic hypertrophy (anticholinergic effects may exacerbate glaucoma and urinary retention); epilepsy or history of epilepsy (drug lowers seizure threshold); breast cancer (elevations in prolactin may stimulate a prolactin-dependent tumor); thyrotoxicosis; peptic ulcer, decreased renal function; myelography within previous 24 h or scheduled within 48 h; exposure to heat or phosphorous insecticides; lactation; children younger than 12 y, especially those with chickenpox, CNS infections (children are especially susceptible to dystonias that may confound the diagnosis of Reye's syndrome); allergy to aspirin if giving the 1-, 2-, 5-, and 10-mg tablets (these tablets contain tartrazine).
Dose:
§ by mouth,, short-term adjunctive management of psychomotor agitation, excitement, and violent or dangerously impulsive behavior, initially 1.5–3 mg 2–3 times daily or 3–5 mg 2–3 times daily in severely affected or resistant patients; adjusted according to response to lowest effective maintenance dose (as low as 5–10 mg daily); Elderly (or debilitated) initially half adult dose; Child initially 25–50 micrograms/kg daily (in 2 divided doses) to max. 10 mg
§ Agitation and restlessness in the elderly, initially 0.5–1.5 mg once or twice daily
§ Short-term adjunctive management of severe anxiety, 500 micrograms twice daily; CHILD not recommended
§ Intractable hiccup, 1.5 mg 3 times daily adjusted according to response; CHILD not recommended
§ Nausea and vomiting, 1 mg daily
§ By intramuscular or by intravenous injection, initially 2–10 mg, then every 4–8 hours according to response to total max. 18 mg daily; severely disturbed patients may require initial dose of up to 18 mg; elderly (or debilitated) initially half adult dose; CHILD not recommended
Nausea and vomiting, 0.5–2 mg

Adverse effects
Not all effects have been reported with haloperidol; however, because haloperidol has certain pharmacologic similarities to the phenothiazine class of antipsychotic drugs, all adverse effects associated with phenothiazine therapy should be kept in mind when haloperidol is used.
  • CNS: Drowsiness, insomnia, vertigo, headache, weakness, tremor, ataxia, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal syndromes--pseudoparkinsonism; dystonias; akathisia, tardive dyskinesias, potentially irreversible (no known treatment), neuroleptic malignant syndrome--extrapyramidal symptoms, hyperthermia, autonomic disturbances
  • CV: Hypotension, orthostatic hypotension, hypertension, tachycardia, bradycardia, cardiac arrest, CHF, cardiomegaly, refractory arrhythmias (some fatal), pulmonary edema
  • Respiratory: Bronchospasm, laryngospasm, Dyspnea; suppression of cough reflex and potential for aspiration
  • Hematologic: Eosinophilia, leukopenia, leukocytosis, anemia; aplastic anemia; hemolytic anemia; thrombocytopenic or nonthrombocytopenic purpura; Pancytopnea
  • Hypersensitivity: Jaundice, urticaria, angioneurotic edema, laryngeal edema, photosensitivity, eczema, asthma, anaphylactoid reactions, exfoliative dermatitis
  • Endocrine: Lactation, breast engorgement in females, galactorrhea; SIADH; amenorrhea, menstrual irregularities; gynecomastia in males; changes in libido; hyperglycemia or hypoglycemia; glycosuria; hyponatremia; pituitary tumor with hyperprolactinemia; inhibition of ovulation, infertility, pseudopregnancy
  • Autonomic: Dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, fever, pallor, flushed faces, sweating, constipation, paralytic ileus, urinary retention, incontinence, Polyuria, enuresis, priapism, ejaculation inhibition
Nursing Considerations
  • Do not give children IM injections.
  • Do not use haloperidol decanoate for IV injections.
  • Gradually withdraw drug when patient has been on maintenance therapy to avoid withdrawal-emergent dyskinesias.
  • Discontinue drug if serum creatinine, BUN become abnormal or if WBC count is depressed.
  • Monitor elderly patients for dehydration; institute remedial measures promptly; sedation and decreased thirst related to CNS effects can lead to severe dehydration.
  • Consult physician regarding appropriate warning of patient or patient's guardian about tardive dyskinesias.
Consult physician about dosage reduction, use of anticholinergic antiparkinsonism drugs (controversial) if extrapyramidal effects occur.