Haloperidol Decanoate

A to Z Drug Facts

 Action Has antipsychotic effect, apparently due to dopamine-receptor blockage in CNS.

 Indications Management of psychotic disorders; control of Tourette's disorder in children and adults; management of severe behavioral problems in children; short-term treatment of hyperactive children. Long-term antipsychotic therapy (haloperidol decanoate). Unlabeled use (s): Treatment of phencyclidine (PCP) psychosis; antiemetic.

 Contraindications Severe toxic CNS depression or comatose states from any cause; Parkinson's disease.

 Route/Dosage

Individualize dosage. ADULTS: PO 0.5 to 40 mg/day in divided doses; up to 100 mg/day in severe cases. ADULTS: IM 0.5 to 5 mg q 60 min; however, q 4 to 8 hr may be satisfactory.

Haloperidol Decanoate

ADULTS: IM (deep injection) Initial dose is 10 to 20 times oral dose. Usually given q 4 wk. CHILDREN 3 to 12 YR: PO Initially 0.5 mg/day. Increase in 0.5 mg increments every 5 to 7 days until therapeutic effect is achieved. Total dose divided and given bid or tid.

 Interactions

Anesthetics, opiates, alcohol: May increase CNS depressant effects. Anticholinergics: May increase anticholinergic effects. May worsen schizophrenic symptoms, decrease haloperidol serum concentrations, and lead to tardive dyskinesia. Carbamazepine: May decrease effects of haloperidol. Lithium: May induce disorientation, unconsciousness, and extrapyramidal symptoms.

 Lab Test Interferences Pregnancy tests: False-positive results may occur; less likely to occur with serum test. Protein-bound iodine: Increases have been reported.

 Adverse Reactions

CV: Orthostatic hypotension; hypertension; tachycardia; ECG changes. CNS: Tardive dyskinesia; tardive dystonia; insomnia; restlessness; anxiety; euphoria; agitation; drowsiness; depression; lethargy; headache; confusion; vertigo; seizures; exacerbation of psychotic symptoms; pseudoparkinsonism (eg, mask-like face, drooling, pill rolling, shuffling gait, inertia, tremors, cogwheel rigidity); muscle spasms; dyskinesia; akathisia; oculogyric crises; opisthotonos; hyperreflexia. DERM: Maculopapular and acneiform skin reactions; photosensitivity; hair loss. EENT: Cataracts; retinopathy; visual disturbances; mydriasis; increased IOP; nasal congestion. GI: Dyspepsia; anorexia; diarrhea; hypersalivation; nausea; vomiting; dry mouth. GU: Impotence; sexual dysfunction; priapism; urinary hesitancy or retention. HEMA: Agranulocytosis; leukopenia; leukocytosis; anemia. HEPA: Jaundice; impaired liver function. RESP: Laryngospasm; bronchospasm; increased depth of respiration. OTHER: Menstrual irregularities; breast enlargement; lactation; gynecomastia; hyperglycemia; hypoglycemia; hyponatremia; elevated prolactin levels; adynamic ileus (may lead to death).

 Precautions

Pregnancy: Haloperidol: Safety not established. Haloperidol decanoate: Category C. Lactation: Excreted in breast milk. Children: Do not use in children < 3 yr. IM form not recommended in children. Elderly or debilitated patients: More susceptible to effects; consider lower dose. Special risk patients: Use drug with caution in patients with cardiovascular disease or mitral insufficiency, history of glaucoma, EEG abnormalities or seizure disorders, prior brain damage, or hepatic or renal impairment. Antiemetic effects: Due to suppression of cough reflex, aspiration of vomitus possible. CNS effects: May impair mental or physical abilities, especially during first few days of therapy. Hepatic effects: Jaundice usually occurs in 2 to 4 wks of treatment and is considered a hypersensitivity reaction. Usually reversible. Neuroleptic malignant syndrome (NMS): Has occurred and is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular BP, tachycardia, and diaphoresis. Sensitivity to neuroleptic drugs: May require lower dosage. Sudden death: Has been reported; predisposing factors may be seizures or previous brain damage. Flareup of psychotic behavior may precede death. Tardive dyskinesia: Syndrome of potentially irreversible, involuntary dyskinetic movements may develop. Prevalence is highest in elderly, especially women. Use smallest effective dose for shortest period of time needed. Tartrazine sensitivity: Note that tartrazine is a component of this product.

 Administration/Storage

• Dilute liquid in fruit juice.
• Observe patient carefully when administering to ensure medication is taken and not hoarded.
• Give with food or full glass of water to minimize GI irritation.
• Replace injectable form by oral form as soon as possible.
• Protect liquid concentrate from light and store in opaque bottle.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for extrapyramidal symptoms and tardive dyskinesia. Notify health care provider if symptoms develop.
• Assess patient's mental status throughout therapy.
• Evaluate CBC and liver function studies before and periodically throughout therapy.
• Assess I & O and bowel function frequently.
• Observe safety precautions such as close patient supervision and removal of harmful objects from patient's environment.
• Increase bulk and fluids in patient's diet to minimize constipation.
• Keep the patient recumbent after IM injection to reduce hypotension.

 Patient/Family Education

• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Instruct patient to use mouth rinses, good oral hygiene, and sugarless gum or candy to relieve dry mouth.
• Advise patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to report these symptoms to health care provider: Drooling, tremors, shuffling gait, restlessness, muscle spasms, aching or numbness, weakness, impaired vision, sore throat, fever, bleeding or bruising, rash, or jaundice.
• Inform patient of possible hair loss.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts