Haldol (A complete review)

Haldol

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.

Haldol (A complete review)

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. 

Haldol (A complete review)
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. 

Haldol (A complete review)
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.

Haldol (A complete review)

Frequently asked questions (FAQs) about Haldol:

1.    What is Haldol?

Haldol in an antipsychotic medicine that is used to treat schizophrenia.

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

2.    What are contra-indications to taking Haldol?

You should not use Haldol if you have Parkinson’s disease or certain conditions that affect your central nervous system.

Haldol is not approved for use in older adults with dementia-related psychosis.

3.    How is Haldol taken?

Haldol can be taken with or without food.

It is usually prescribed orally in tablet or liquid form.

But sometimes they are given as injections.

4.    What should I avoid while taking Haldol?

Drinking alcohol with Haldol can cause side effects.

You should avoid driving or hazardous activity until you know how the medicine will affect you, as reactions could be impaired.

Don’t get up too fast from sitting or lying as you could feel dizzy. 

5.    What are common side effects of taking Haldol?

·      drowsiness

·      headache

·      dizziness, spinning sensation

·      uncontrolled muscle movements

·      feeling restless or anxious

·      sleep problems

·      breast enlargement, irregular menstrual periods.

6.    What other drugs will affect Haldol?

Haldol can cause a serious heart problem.

Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Using Haldol with other drugs that make you drowsy can worsen this effect.

Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:
·       lithium

·       rifampin

·       medicine to treat Parkinson’s disease

·       seizure medicine

·       a blood thinner like warfarin.

7.    Why is Haldol used in hospices?

In hospice, it is used to treat terminal delirium, severe agitation in end-stage dementia.

Sometimes it’s also used in the treatment of nausea and vomiting and can even be used to treat intractable hiccups.

8.    Is Haldol a narcotic?

Haldol is not a narcotic; it’s categorized as an antipsychotic drug and is the most commonly prescribed antipsychotic.

If you are further interested in information around Haldol or schizophrenia, here is some suggested reading material:

A Room with a Darker View: Chronicles of My Mother and Schizophrenia

A Room with a Darker View is an unflinching, feminist work that chronicles the author’s troubled relationship with her mother, an Oxford-trained lawyer, whose severe illness — marked by manic bouts of laughter, delusions, and florid hallucinations — went unrecognized for decades.

Told in fragments, flashbacks, and chronicling the most extreme but unfortunately common aspects of schizophrenia, this elegantly written memoir is a reflection on illness, shame, and the generation gaps that have defined mother-daughter relationships amid the evolution of feminism in the 20th century. 

Haldol and Hyacinths: A Bipolar Life

Born to Persian parents at the height of the Islamic Revolution and raised amid a vibrant, loving, and gossipy Iranian diaspora in the American heartland, Melody Moezzi was bound for a bipolar life.

At 18, she began battling a severe physical illness, and her community stepped up, filling her hospital rooms with roses, lilies and hyacinths.

But when she attempted suicide and was diagnosed with bipolar disorder, there were no flowers.

Despite several stays in psychiatric hospitals, bombarded with tranquilizers, mood-stabilizers, and anti-psychotics, she was encouraged to keep her illness a secret—by both her family and an increasingly callous and indifferent medical establishment.

Refusing to be ashamed or silenced, Moezzi became an outspoken advocate, determined to fight the stigma surrounding mental illness and reclaim her life along the way.

Surviving Schizophrenia, 7th Edition: A Family Manual

Updated throughout and filled with all the latest research, treatment plans, commonly asked questions and more, the bestselling resource on schizophrenia is back—now in its seventh edition.

Since its first publication in 1983, Surviving Schizophrenia has become the standard reference book on the disease and has helped thousands of patients, their families, and mental health professionals.

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

Aura Des los Santos

Aura Des los Santos is a Clinical Psychologist with two masters degree in Education. One focused in Higher Educacion and the other in the research of Psychology of Education. Her experience is focused on working depression, anxiety and personal development. She frequently writes articles in the area of psychology, education, travel and general culture.