ADMINISTRATION ROUTES:
IV, IM, PO
ALTERNATIVE NAMES:
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
ICU INDICATIONS:
- Delirium
- Psychosis
PRESENTATION AND ADMINISTRATION:
IV:
Haloperidol 5 mg in 1 mL (solution)
Administer slowly over 1-2 minutes or as a bolus, undiluted or diluted in 5-10 mL of Normal saline
May be diluted in compatible IV fluid and administered over 10-30 mins
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 0.75 mg/mL), 5% dextrose (up to a concentration of 3 mg/mL), Glucose and sodium chloride (up to a concentration of 1 mg/mL), Hartmanns (up to a concentration of 1 mg/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 2 mg/mL (20 drops is equal to 1 mL)
DOSAGE:
IV/IM:
ICU delirium and psychosis
0.5 mg - 10 mg as required
Usual maximum daily dose 100 mg although much higher doses have been described
PO:
0.5 mg - 20 mg as required
Usual maximum daily dose is 100 mg although much higher doses have been described
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | Start with lower doses unless only giving single dose. Accumulates with repeated dosage |
| 10-20 | Dose as in normal renal function |
| >20-50 | Start with lower doses unless only giving single dose. Accumulates with repeated dosage |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | Start with lower doses unless only giving single dose. Accumulates with repeated dosage |
| HD | Start with lower doses unless only giving single dose. Accumulates with repeated dosage |
| CVVHDF | Dose as in normal renal function |
DOSAGE IN PAEDIATRICS:
IV, IM, PO:
0.01 mg/kg daily, increased to 0.1 mg/kg BD
CLINICAL PHARMACOLOGY:
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
IMPORTANT DRUG INTERACTIONS IN ICU:
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
ADVERSE REACTIONS:
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, gynaecomastia, 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