Haloperidol

INTRODUCTION

Indications

Acute and chronic psychotic disorders, including schizophrenia, manic states, drug-induced psychoses. Schizophrenic patients who require long-term parenteral (IM) antipsychotic therapy. Also useful in managing aggressive or agitated patients. Tourette's syndrome. Severe behavioral problems in children which may be accompanied by unprovoked, combative, explosive hyperexcitability, hyperactivity accompanied by conduct disorders (short-term use when other modalities have failed). Considered second-line treatment after failure with atypical antipsychotic.

Unlabeled Use: Nausea and vomiting from surgery or chemotherapy.

Action

Alters the effects of dopamine in the CNS. Also has anticholinergic and alpha-adrenergic blocking activity. Therapeutic Effects: Diminished signs and symptoms of psychoses. Improved behavior in children with Tourette's syndrome or other behavioral problems.

Adverse Reactions/Side Effects

CNS: SEIZURES, extrapyramidal reactions, confusion, drowsiness, restlessness, tardive dyskinesia. EENT: blurred vision, dry eyes. Resp: respiratory depression. CV: hypotension, tachycardia. GI: constipation, dry mouth, anorexia, drug-induced hepatitis, ileus, weight gain. GU: urinary retention. Derm: diaphoresis, photosensitivity, rashes. Endo: galactorrhea, amenorrhea. Hemat: anemia, leukopenia. Metab: hyperpyrexia. Misc: NEUROLEPTIC MALIGNANT SYNDROME, hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor and report signs of neuroleptic malignant syndrome (hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure [BP], incontinence). Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use.

• Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).

  • Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, masklike face).

  • Akathisia (restlessness or desire to keep moving).

  • Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess BP periodically, and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

• Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendixes G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

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