Haldol (A complete review)

What is Haldol ?

Haldol (haloperidol) is an antipsychotic medicine used to treat schizophrenia.

It is also used to control motor and speech tics in people with Tourette’s syndrome.

In this article, you will learn what Haldol is used to treat, how it works, common side effects, and other important information regarding usage. 

What is Haldol used for?

Schizophrenia is a severe, long-term mental health condition that requires lifelong treatment, even when symptoms have subsided.

Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications like Haldol are the most commonly prescribed drugs. 

Haldol is one of the first generation antipsychotic medications, meaning discovered in the 1950s.

It was first discovered in 1958 and formed one of the greatest breakthroughs in psychiatry.

However, first-generation antipsychotics have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible.

Newer, second-generation medications are often preferred because they pose a lower risk of serious side effects than do first-generation antipsychotics.

How is Haldol taken?

Haldol is available in different forms and is widely prescribed in many countries.

The most common route of administration is the oral route for oral administration, haloperidol is available in the form of tablets and oral concentrate. It is also available as a nasal spray.

Haloperidol lactate is a short-acting parenteral, meaning non-digestive tract application, solution for intramuscular and intravenous administration.

Haloperidol decanoate is a long‐acting intramuscular preparation. 

Patients generally prefer oral haloperidol, a convenient route involving no needles.

However, cognitive dysfunction, often caused by schizophrenia, coupled with the side effects of Haldol, might cause patients to refuse to adhere to the treatment, and this poses an increased risk of poor adherence especially to the oral form because it is usually difficult to quantify patients’ compliance to the pills.

The oral route is also relatively slow, reaching peak plasma concentration in 1.7 to 6.1 hours, compared with 15 minutes in intranasal and intravenous routes and 37.5 minutes in intramuscular usage.

Parenteral routes are therefore preferred in acute schizophrenia.

Intramuscular haldol lactate is used for prompt control of patients with acute agitation, where frequent doses are injected until symptoms are controlled before switching to oral therapy.

Another parenteral form, haloperidol decanoate, provides a slow and prolonged release when administered as a depot intramuscular injection which helps eliminate the problems of non‐compliance.

Recently, a new, non‐invasive intranasal route was introduced for haldol, which provides a direct nose‐to‐central nervous system delivery with no first‐pass metabolism, thus ensures a rapid uptake in the brain, enabling its application in psychiatric emergencies when there is no intravenous access. 

Schizophrenia is a severe, long-term mental health condition

What are the symptoms of schizophrenia?

Schizophrenia is a severe, long-term mental health condition. It causes a range of different psychological symptoms.

Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.

Schizophrenia does not cause someone to be violent and people with schizophrenia do not have a split personality.

Symptoms include:

·      hallucinations – hearing or seeing things that do not exist outside of the mind

·      delusions – unusual beliefs not based on reality  

·      muddled thoughts based on hallucinations or delusions 

·      losing interest in everyday activities

·      not caring about your personal hygiene

·      wanting to avoid people, including friends.

Some people with bipolar disorder also experience psychotic symptoms.

Also, a person can have both schizophrenia and bipolar disorder, which can complicate diagnosis.

Some people have schizoaffective disorder, which involves a combination of schizophrenia symptoms and those of a mood disorder.

What is Tourette’s syndrome?

Tourette’s syndrome is a condition that causes a person to make involuntary sounds and movements called tics.

It usually starts during childhood, but the tics and other symptoms usually improve after several years and sometimes go away completely. 

There is no cure for Tourette’s syndrome, but treatment with medications that block or lessen dopamine, such as Haldol, can help manage symptoms.

People with Tourette’s syndrome may also have obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) or learning difficulties.

How does Haldol work?

Haldol works by blocking a variety of receptors in the brain, particularly dopamine receptors.

Dopamine is a natural compound called a neurotransmitter, and is involved in transmitting messages between brain cells.

Schizophrenia symptoms such as hearing voices, disorganized speech, hallucinations, hostility and psychomotor agitation (such as pacing, tapping toes etc.) are thought to be managed by the highly effective Haldol medication.

Haldol shows fewer side effects within its class, but shows stronger extrapyramidal symptoms than other first-generation, antipsychotic drugs such as Chlorpromazine, Zuclopenthixol, Fluphenazine and Methotrimeprazine.

Low‐potency medications have a lower affinity for dopamine receptors so that a higher dose is required to treat symptoms of schizophrenia effectively.

In addition, they block many receptors on top of the primary target (dopamine receptors), such as cholinergic or histaminergic receptors, resulting in a higher incidence of side effects such as sedation, weight gain and hypotension.

The balance between the desired drug effects on psychotic symptoms and unwanted side effects are primarily at play within dopaminergic brain pathways affected by Haldol. 

Treatment is a balance between the desired drug effects on psychotic symptoms and unwanted side effects

What are the side-effects of Haldol?

Side effects of Haldol include prolonging of the QT heartbeat interval (the term QT refers to the portion of the tracing on an electrocardiogram (EKG) that reflects the change in heart rhythm), mental status changes, death in the elderly, tardive dyskinesia (involuntary movements), prolonged erection (hours), irregular heartbeats, renal failure, a symptom complex sometimes referred to as neuroleptic malignant syndrome (NMS) with fever and prolonging of the QT heartbeat interval. Some other side effects include:

·      nausea & vomiting

·      dizziness & drowsiness

·      insomnia

·      restlessness

·      anxiety

·      skin rash & itching

·      spontaneous eye movements 

·      mood swings.

Are there long-term effects of taking Haldol?

A syndrome consisting of potentially irreversible, involuntary dyskinetic movements may develop in patients.

Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome.

Cases of sudden death, QT-prolongation and Torsade de Pointes have been reported in patients receiving Haldol.

Higher than recommended doses of any formulation and intravenous administration of haldol appear to be associated with a higher risk of QT-prolongation and Torsade de Pointes.

Although cases have been reported even in the absence of predisposing factors, particular caution is advised in treating patients with other QT-prolonging conditions (including electrolyte imbalance [particularly hypokalemia and hypomagnesemia], drugs known to prolong QT, underlying cardiac abnormalities, hypothyroidism and familial long QT-syndrome).

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

Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status (including catatonic signs) and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias).

Additional symptoms may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure.

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What we recommend for Schizophrenia

Professional counselling

If you have schizophrenia then ongoing professional counselling could be your ideal first point of call. Counselling will allow you to practice various habits that improve your overall quality of life.

Frequently asked questions (FAQs) about Haldol:

References:

Haldol – Drugs.com – February 2020

Schizophrenia Health Center – WebMD – January 2020

Schizophrenia – NHS UK – November 2019

Schizophrenia – Mayo Clinic – December 2019

Tourette Syndrome – Mayo Clinic – January 2020