1 vial

$1.87

1 tablet 0.5mg

5 cents

Serenace

Note: this monograph does
not apply to Haldol (Haloperidol decanoate) which has an extended duration of action, is administered by IM depot injection and is not used in ICU

  • Delirium

  • Psychosis

IV:
Haloperidol 5mg in 1ml (solution)
Administer slowly over 1-2 minutes or as a bolus, undiluted or diluted in 5-10ml of normal saline.
May be diluted in compatible IV fluid and administered over 10-30 minutes
Undiluted solution may discolour if exposed to light. Discoloured solutions should not be used.
Compatible with the following IV fluid subject to concentration limits:
Normal saline up to a concentration of 0.75mg/ml
5% dextrose up to a concentration of 3mg/ml
Glucose and sodium chloride up to a concentration of 1mg/ml
Hartmanns up to a concentration of 1mg/ml
Store at room temperature and protect from light

PO:
Tablets:
Serenace 0.5mg tablets (green), Serenace 1.5mg (white), Serenace 5mg (red)
Liquid:
Serenace 2mg/ml (20 drops is equal to 1ml)


ADULT DOSE

IV/IM:
ICU delirium and psychosis
0.5mg-10mg as required. Usual maximum daily dose is 100mg although much higher doses have been described.

PO:
0.5mg-20mg as required. Usual maximum daily dose is 100mg although much higher doses have been described.

PAEDIATRIC DOSE

IV, IM, PO:
0.01mg/kg daily; increased to 0.1mg/kg 12 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose in renal impairment [GFR (ml/min)]
<10 start with lower doses. For single doses use 100% of normal dose. Avoid repeated dosage because of accumulation
10-20 dose as in normal renal function
>20-50 dose as in normal renal function

Dose in renal replacement therapy
CAPD start with lower doses. For single doses use 100% of normal dose. Avoid repeated dosage because of accumulation
HD start with lower doses. For single doses use 100% of normal dose. Avoid repeated dosage because of accumulation
CVVHDF dose as in normal renal function

Haloperidol is the first of the butyrophenone series of major tranquilisers. The precise mechanism of action has not been clearly established.

CONTRAINDICATIONS:

  • Hypersensitivity to haloperidol

  • Parkinson’s disease


WARNINGS
Tardive Dyskinesia
A syndrome consisting of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs. The syndrome usually develops with high doses given over a prolonged period; however, it can develop, although much less commonly, after relatively brief treatment periods at low doses.

Neuroleptic Malignant Syndrome (NMS)
A potentially fatal symptom complex referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs.

PRECAUTIONS
General
Haloperidol may lower the seizure threshold
Severe neurotoxicity (rigidity, inability to walk or talk) may occur in patients with thyrotoxicosis who are also receiving antipsychotic medication, including haloperidol.

Laboratory Tests
No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions
None noted

Combined Use of Haloperidol and Lithium
An encephalopathic syndrome (characterised by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS) followed by irreversible brain damage has occurred in a few patients treated with lithium plus haloperidol. A causal relationship between these events and the concomitant administration of lithium and haloperidol has not been established; however, patients receiving such combined therapy should be monitored closely for early evidence of neurological toxicity and treatment discontinued promptly if such signs appear.

Body as a Whole:
Neuroleptic malignant syndrome (NMS), hyperpyrexia and heat stroke have been reported with haloperidol.
Central Nervous System:
Extrapyramidal Symptoms (EPS), tardive dyskinesia, insomnia, restlessness, anxiety, euphoria, agitation, drowsiness, depression, lethargy, headache, confusion, vertigo, grand mal seizures, exacerbation of psychotic symptoms including hallucinations, and catatonic-like behavioural states
Cardiovascular:
Tachycardia, hypotension, hypertension and ECG changes including prolongation of the Q-T interval and torsades de pointes.
Haematological:
Mild and usually transient leukopaenia and leukocytosis, minimal decreases in red blood cell counts, anaemia, or a tendency toward lymphomonocytosis. Agranulocytosis has rarely been reported to have occurred with the use of haloperidol, and then only in association with other medication.
Endocrine Disorders:
Lactation, breast engorgement, mastalgia, menstrual irregularities, gynecomastia, impotence, increased libido, hyperglycaemia, hypoglycaemia and hyponatraemia.
Gastrointestinal Effects:
Anorexia, constipation, diarrhoea, hypersalivation, dyspepsia, jaundice, nausea and vomiting.
Autonomic Reactions:
Dry mouth, blurred vision, urinary retention, diaphoresis and priapism.
Respiratory Effects:
Laryngospasm, bronchospasm and increased depth of respiration.

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