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Name: Haloperidol

Pregnancy Category C

Drug classes

• Dopaminergic blocking drug
• Antipsychotic drug Butyrophenone (not a phenothiazine)

Therapeutic actions

Mechanism of action not fully understood: antipsychotic drugs block postsynaptic dopamine receptors in the brain, depress the reticular activating system, including those parts of the brain involved with wakefulness and emesis; chemically resembles the phenothiazines.

Indications

1. Management of manifestations of psychotic disorders
2. Control of tics and vocalizations in Gilles de la Tourette's syndrome in adults and children
3. Short-term treatment of hyperactive children who also show impulsivity, difficulty sustaining attention, aggressivity, mood lability, or poor frustration tolerance
4. Prolonged parenteral therapy of chronic schizophrenia (haloperidol decanoate)
5. Unlabeled uses: control of nausea and vomiting, control of acute psychiatric situations (IV use)

Contraindications/cautions

Contraindicated in the presence of 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 caution in the presence of respiratory disorders ("silent pneumonia" may develop); 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).

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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; pancytopenia
• 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 facies, sweating, constipation, paralytic ileus, urinary retention, incontinence, polyuria, enuresis, priapism, ejaculation inhibition

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