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Haloperidol (Haldol)

Halo-poodle
Picmonic
Haloperidol (Haldol) is the most commonly used first-generation antipsychotic medication and acts as a dopamine antagonist. By blocking the dopamine receptors, haloperidol decreases activity of the dopaminergic tracts in the central nervous system and lowers the therapeutic effects of levodopa. Haloperidol is primarily indicated for migraines and schizophrenia but may also be used for psychosis, mania, and delirium.
9 KEY FACTS
MECHANISM
High Potency Antipsychotic
High Pot Ant-tie-psychiatrist

Haloperidol is a high-potency antipsychotic. Potency refers to the dosing amount necessary to elicit a therapeutic effect. Therefore, a smaller amount of a high-potency drug yields similar effects of a larger amount of a low-potency drug. High potency antipsychotics have a higher incidence of extrapyramidal side effects when compared to low potency ones. Haloperidol is considered a major tranquilizer.

INDICATIONS
Migraine
Mind-rain

Although considered as an off-label use, the dopamine antagonist effects of Haloperidol may be used to decrease dopaminergic hyperactivity that is associated with migraine headaches.

Schizophrenia
Sketchy-fern

Schizophrenia has been associated with excess levels of dopamine activity in the brain. Haloperidol is a neuroleptic medication that blocks dopamine receptors and decrease schizophrenic symptoms.

SIDE EFFECTS
Extrapyramidal Symptoms
X-Pyramid

Prolonged or excessive use of haloperidol decreases dopamine activity and causes movement disorders known as extrapyramidal effects. Early symptoms include acute dystonia, parkinsonism, and akathisia. Later symptoms include tardive dyskinesia, that manifests as repetitive and involuntary movements.

Weight Gain
Up-arrow Weight-scale

Excessive or prolonged use of haloperidol affects hormonal levels and subsequently metabolic processes that affect glucose levels, lipid levels, and ultimately lead to weight gain.

QT Prolongation
QT-heart Prolonged

Haloperidol may cause QT prolongation by blocking potassium channels and resulting in serious cardiac dysrhythmias. It is important to avoid administering Haloperidol with other QT-prolonging drugs, such as amiodarone or erythromycin because it may potentiate cardiac dysrhythmias. To decrease the risk of dysrhythmias, the patient should have an ECG and potassium test completed prior to treatment.

Restlessness
Restless-wrestler

Akathisia is characterized by restlessness and manifests as constantly moving. Although the exact cause remains unknown, akathisia has been associated with medications such as Haloperidol (Haldol) that block dopaminergic transmission in the brain. Akathisia can be resolved by switching to a low-potency antipsychotic or using other medications (beta blockers, benzodiazepines, anticholinergics) to suppress symptoms.

CONSIDERATIONS
Caution in Seizure Patients
Caution-sign Caesar-patient

Haloperidol should be administered with caution because antipsychotics lower the seizure threshold and therefore increase the risk of seizures. Seizures may occur in susceptible individuals with seizure disorders or with excessive doses of haloperidol. During treatment, the patient should be monitored.

Neuroleptic Malignant Syndrome
Nerve-leopard and Malignant-man

Excessive amounts of haloperidol may cause neuroleptic malignant syndrome, which is a condition that affects multiple organ systems and ultimately leads to death. Symptoms of neuroleptic malignant syndrome include rigidity, sudden hyperthermia, and autonomic instability characterized by fluctuations in blood pressure and heart rhythms. Other symptoms include altering level of consciousness, seizures, and comas. It is important to immediately cease the medication and initiate supportive measures.

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