Haloperidol

PHARMACOLOGY

Dopamine-receptor antagonist. Inhibitory effect on the area postrema (chemoreceptor trigger zone). In palliative care haloperidol has been used for nausea, vomiting, delirium and intractable hiccup. Can be given PO, SC or IV

Onset of action: 10-15 minutes SC; >1 h PO
Duration of action: usually 24 h
Plasma ½ life: 13-35 h

DOSING

  • Antiemetic: starting dose 0.5-2 mg once daily HS; usual dose 3-5 mg once daily HS or in divided doses/day; maximum 10-20 mg once daily HS or in divided doses/day
  • Antipsychotic/anxiolytic: 0.5-5 mg bid PO or SC
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  • 0.05-0.15 mg/kg/24h in divided doses bid or tid PO/SC/IV

UNWANTED EFFECTS

  • Extrapyramidal effects: acute dystonias, pseudoparkinsonism and akathisia (restlessness)
  • Hypotension
  • Sedation

PITFALLS/CONCERNS

  • Should not be used in Parkinson’s disease
  • Watch for extrapyramidal effects. If present decrease or discontinue haloperidol and treat symptoms using anticholinergics (benztropine), beta-blockers or benzodiazepines if necessary

NOTE

This information is drawn from a number of sources (see below). The reader is encouraged to access these and other relevant literature for more detail. As always, sound clinical judgment should be used in individual clinical cases. In particular, it should be remembered that there may be significant variation in the pharmokinetics of a drug resulting from a number of factors, including the individual patient’s metabolism/disease status and how the medication has been formulated.

SOURCES/REFERENCES

  1. Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s: the pharmacological basis of therapeutics. 11th ed. McGraw-Hill Professional; 2006.
  2. Twycross R, Wilcock A. Palliative care formulary. 3rd ed. Radcliffe Medical Press Ltd; 2008.
  3. Repchinsky C, editor. Compendium of pharmaceuticals and specialties (CPS): the Canadian drug reference for health professionals. 44th ed. Canadian Pharmacists Association; 2009.
  4. Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children. 1st ed. Oxford University Press; 2006.

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