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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.