Home Drug Guide Haloperidol Decanoate

Drug Guide

Generic Name

Haloperidol Decanoate

Brand Names Haldol Decanoate

Classification

Therapeutic: Antipsychotic, typical (first-generation)

Pharmacological: Dopamine D2 receptor antagonist

FDA Approved Indications

Schizophrenia
Schizoaffective disorder (maintenance treatment)

Mechanism of Action

Blocks dopamine D2 receptors in the brain, reducing psychotic symptoms.

Dosage and Administration

Adult: Typically administered every 4 weeks via intramuscular injection, dose varies based on patient response and prior therapy.

Pediatric: Not FDA-approved for pediatric use; off-label use under certain circumstances with caution.

Geriatric: Use with caution due to increased sensitivity to side effects; dosing adjustments are common.

Renal Impairment: No specific adjustment necessary, but monitor response.

Hepatic Impairment: Use with caution; no specific adjustments established.

Pharmacokinetics

Absorption: Slowly absorbed after intramuscular injection.

Distribution: Widely distributed in tissues, crosses blood-brain barrier.

Metabolism: Metabolized in the liver via CYP3A4.

Excretion: Excreted primarily in urine as metabolites.

Half Life: Approximately 3 weeks (very long-acting depot formulation).

Contraindications

Coma
Pts with Parkinson's disease
Historically hypersensitive to haloperidol or other butyrophenones.

Precautions

Use cautiously in elderly with dementia-related psychosis; risk of mortality.
Monitor for neuroleptic malignant syndrome, extrapyramidal symptoms, tardive dyskinesia.
Pregnancy category C; benefits vs risks should be considered.

Adverse Reactions - Common

Extrapyramidal symptoms (EPS) (Common)
Sedation (Common)
Weight gain (Less common)

Adverse Reactions - Serious

Neuroleptic malignant syndrome (NMS) (Rare)
QT prolongation and arrhythmias (Rare)
Tardive dyskinesia (Rare)

Drug-Drug Interactions

CNS depressants
Other dopamine antagonists (antipsychotics, metoclopramide)
QT prolonging agents (amiodarone, certain antibiotics)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, motor and neurological side effects, cardiac status, and vital signs.

Diagnoses:

Risk for injury (due to EPS or sedation)
Imbalanced nutrition: less than body requirements

Implementation: Administer injection deep into gluteal muscle; monitor for side effects; adjust dose as needed.

Evaluation: Assess for symptom control, adverse effects, and adherence.

Patient/Family Teaching

Report any involuntary movements, fever, muscle rigidity, or unusual tiredness.
Take medication as prescribed, even if feeling well.
Avoid alcohol and other CNS depressants.
Be aware of potential side effects and when to seek medical help.

Special Considerations

Black Box Warnings:

Increased mortality in elderly patients with dementia-related psychosis.
QT interval prolongation, which can lead to serious arrhythmias.

Genetic Factors: Metabolism may vary with CYP2D6 polymorphisms.

Lab Test Interference: May cause false positives in certain drug screens.

Overdose Management

Signs/Symptoms: Drowsiness, agitation, extrapyramidal symptoms, hypotension, seizures, coma.

Treatment: Supportive care, monitor cardiac function, manage symptoms, consider activated charcoal if recent ingestion, and specific interventions for complications.

Storage and Handling

Storage: Store at room temperature, protected from light and moisture.

Stability: Stable under proper storage conditions.