Nurses Compass
Drug Guide
Haloperidol Lactate
Classification
Therapeutic: Antipsychotic (Neuroleptic)
Pharmacological: Butyrophenone Derivative
FDA Approved Indications
- Schizophrenia
- Acute psychosis
- Tic disorders (e.g., Tourette syndrome)
- Hiccups (off-label)
Mechanism of Action
Haloperidol blocks dopamine D2 receptors in the brain, reducing dopaminergic neurotransmission, which alleviates psychotic symptoms.
Dosage and Administration
Adult: Typically 2-10 mg orally two to three times daily; dosage adjusted based on clinical response and tolerability.
Pediatric: Dosing varies; usually 0.05-0.15 mg/kg/day divided into two or three doses, not to exceed 12 mg/day.
Geriatric: Start at lower doses, e.g., 0.5-1 mg twice daily, and titrate slowly.
Renal Impairment: Use with caution; no specific dose adjustment established, monitor for toxicity.
Hepatic Impairment: Use with caution; dose reduction may be necessary, monitor liver function.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses the blood-brain barrier.
Metabolism: Extensively metabolized in the liver by CYP3A4 and CYP2D6 enzymes.
Excretion: Primarily via urine as metabolites.
Half Life: Approximately 20 hours.
Contraindications
- Parkinson's disease
- Comcomitant use with linezolid or methylene blue (serotonin syndrome risk)
- Known hypersensitivity to haloperidol
Precautions
- History of seizures
- Cardiovascular disease (QT prolongation risk)
- Dementia-related psychosis (increased mortality risk in elderly)
- Pregnancy and lactation: Use only if clearly needed; safety not established.
Adverse Reactions - Common
- Extrapyramidal symptoms (dystonia, akathisia, Parkinsonism) (Common)
- Sedation (Common)
- Hypotension (Common)
- Dry mouth, blurred vision, urinary retention (Common)
Adverse Reactions - Serious
- QT prolongation and torsades de pointes (Rare)
- Neuroleptic malignant syndrome (NMS) (Rare)
- Leukopenia, neutropenia, agranulocytosis (Rare)
- TD (Tardive dyskinesia) with long-term use (Potentially irreversible)
Drug-Drug Interactions
- Other CNS depressants, including alcohol and opioids
- Anticholinergic agents (potentiation of anticholinergic effects)
- Metoclopramide, other dopamine antagonists
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, QT prolongation, vital signs, and mental status.
Diagnoses:
- Risk for injury related to extrapyramidal symptoms or orthostatic hypotension.
- Imbalanced nutrition: Less than body requirements due to sedation.
Implementation: Administer with food or milk to decrease gastrointestinal irritation. Monitor ECGs in at-risk patients. Adjust doses based on clinical response and side effects.
Evaluation: Assess for resolution of psychotic symptoms, minimize side effects, and ensure patient safety.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Notify healthcare provider if experiencing muscle stiffness, tremors, fever, or unusual movements.
- Avoid alcohol and operating heavy machinery until stabilized.
- Report any signs of abnormal heart rhythm, such as palpitations or dizziness.
Special Considerations
Black Box Warnings:
- Elderly patients with dementia-related psychosis treated with antipsychotics are at increased risk of death.
Genetic Factors: Patients with CYP2D6 poor metabolizer phenotype may have increased plasma levels.
Lab Test Interference: May cause false positives in urinary catecholamine tests.
Overdose Management
Signs/Symptoms: Extrapyramidal symptoms, hypotension, altered mental status, seizures, coma.
Treatment: Supportive care, manage symptoms, activated charcoal if recent ingestion, and symptomatic treatment. Cardiac monitoring for QT prolongation.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable at room temperature for at least 24 months.