• Psychosis

Psychosis:

Indications for HALDOL INJECTION:

Schizophrenia. Tourette's disorder.

Adult:

Individualize. 2–5mg IM every 4–8hrs or up to hourly if needed; max: 20mg/day. Switch to oral form 12–24hrs after last injection.

Children:

Not established.

Contraindications:

Severe toxic CNS depression. Coma. Parkinson's disease. Dementia with Lewy bodies.

Boxed Warning:

Increased mortality in elderly patients with dementia-related psychosis.

Warnings/Precautions:

Elderly with dementia-related psychosis (not approved use): increased risk of death. Risk of QT prolongation: electrolyte disturbances (eg, hypokalemia, hypomagnesemia), underlying cardiac abnormalities, hypothyroidism, familial long QT-syndrome, concomitant drugs known to prolong the QT interval. Seizures. Thyrotoxicosis. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1st few months of treatment; discontinue if WBCs decline or ANC <1000/mm3. Severe cardiovascular disorders. Mania. Perform fall risk assessments when initiating and recurrently on long-term therapy. Hepatic impairment. Debilitated. Avoid abrupt cessation. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy. Nursing mothers: not recommended.

Pharmacologic Class:

Butyrophenone.

Interactions:

CNS depression potentiated with alcohol (avoid), other CNS depressants. Possible neurotoxicity with lithium: monitor, discontinue if occurs. Caution with drugs that prolong the QT interval (eg, ketoconazole, paroxetine). May be potentiated by CYP3A4 or CYP2D6 inhibitors/substrates (eg, itraconazole, nefazodone, buspirone, venlafaxine, alprazolam, fluvoxamine, quinidine, fluoxetine, sertraline, chlorpromazine, promethazine. May be antagonized by CYP3A4 inducers (eg, rifampin, carbamazepine); monitor and adjust doses. May potentiate CYP2D6 substrates (eg, desipramine, imipramine). May impair effects of levodopa, other dopamine agonists. May increase intraocular pressure with anticholinergics, antiparkinson agents. Monitor anticoagulants.

Adverse Reactions:

Tardive dyskinesia, neuroleptic malignant syndrome, extrapyramidal symptoms, hyperpyrexia, heat stroke, bronchopneumonia, cardiovascular effects, hematological effects, GI upset, anticholinergic effects; QT prolongation, Torsades de Pointes, dystonia, hypersensitivity reactions.

How Supplied:

Inj (1mL amps)—10; Decanoate 50 (1mL amps)—3; Decanoate 100 (1mL amps)—5