Haldol Decanoate (Haloperidol Decanoate): Side Effects, Interactions, Warning, Dosage & Uses

Haldol Decanoate

haldol decanoate storage

In addition, inhibition of CYP3A4 by eythromycin may result in elevated haloperidol concentrations, thereby increasing the risk of adverse effects, including QT prolongation. In addition, the plasma concentrations of loperamide, a CYP2D6 substrate, may be increased when administered concurrently with haloperidol, a CYP2D6 inhibitor, further increasing the risk of toxicity. Also, based on observations in patients in a state of alcoholic delirium, high intravenous doses of clonidine may increase the arrhythmogenic potential QT prolongation, ventricular fibrillation of high intravenous doses of haloperidol. QT prolongation should be expected with the administration of arsenic trioxide. Haloperidol is extensively metabolized in the liver and should be used with caution in patients with pre-existing hepatic disease.

Haldol Decanoate - Clinical Pharmacology

You may report side effects to Health Canada at Chlorprothixene Clopenthixol Flupentixol Tiotixene thiothixene Zuclopenthixol. In general, avoid traditional antipsychotic use during therapy for Parkinson's disease unless the benefit of the drug outweighs the risk of decreased therapeutic response to levodopa or other treatments. The available cytogenetic evidence is considered too inconsistent to be conclusive at this time. It has been postulated that lethargy and decreased sensation of thirst due to central inhibition may lead to dehydration , hemoconcentration and reduced pulmonary ventilation. Prescribers need to weigh the potential benefits and risks of abarelix use in patients that are taking drugs that can cause QT prolongation.

Increased serum concentrations of propoxyphene would be expected from concurrent use of a CYP2D6 inhibitor, such as haloperidol. Concurrent use of haloperidol and tramadol increases plasma levels of tramadol and decreases the concentration of the active tramadol metabolite. This may lead to decreased analgesic effects of tramadol and possibly increased tramadol-induced side effects, including seizures, due to increased tramadol concentrations and the decrease in seizure threshold caused by haloperidol.

Additive CNS depression may also be seen with the concomitant use of tramadol and haloperidol. Major QT prolongation has been observed during haloperidol treatment. Use of haloperidol and medications known to cause electrolyte imbalance may increase the risk of QT prolongation.

Therefore, caution is advisable during concurrent use of haloperidol and acetazolamide. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS or psyhcotropic activity.

Minor Haloperidol can potentiate the actions of other CNS depressants, such as opiate agonists, Caution should be exercised with simultaneous use of these agents due to potential excessive CNS effects. Major QT prolongation and torsade de pointes TdP have been observed during haloperidol treatment. Excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation.

According to the manufacturer of haloperidol, caution is advisable when prescribing the drug concurrently with medications known to prolong the QT interval, including alfuzosin. Moderate In general, antipsychotics like haloperidol should be used cautiously with antihypertensive agents due to the possibility of additive hypotension.

Major In general, antipsychotics like haloperidol should be used cautiously with antihypertensive agents due to the possibility of additive hypotension. The risk of QT prolongation may also be increased during use of haloperidol and medications known to cause electrolyte imbalance such as thiazide diuretics. Moderate Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and CYP3A4 substrates such as alprazolam.

Until more data are available, it is advisable to closely monitor for adverse events when alprazolam is coadministered with haloperidol. Concomitant administration of alprazolam with CNS-depressant drugs including antipsychotics can potentiate the CNS effects e.

Moderate Although the mechanism of amantadine is not clear, it appears it potentiates the actions of dopamine. Since butyrophenones are dopamine antagonists, these drugs should be avoided when possible in patients with Parkinson's disease who require amantadine treatment. Moderate In general, haloperidol should be used cautiously with antihypertensive agents due to the possibility of additive hypotension.

According to the manufacturer of haloperidol, caution is advisable when prescribing the drug concurrently with medications known to prolong the QT interval.

Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and inhibitors of CYP3A4 or CYP2D6. Therefore, it is advisable to closely monitor for adverse events when haloperidol is co-administered with drugs that inhibit CYP3A4 and CYP2D6 and prolong the QT interval, such as amiodarone. Due to the extremely long half-life of amiodarone, a drug interaction is possible for days to weeks after discontinuation of amiodarone.

Moderate Haloperidol can potentiate the actions of other CNS depressants, such as benzodiazepines, Caution should be exercised with simultaneous use of these agents due to potential excessive CNS effects. Moderate Use caution during co-administration of amoxapine and antipsychotics. Amoxapine exhibits some antipsychotic activity and may increase the risk of tardive dyskinesia or neuroleptic malignant syndrome NMS when antipsychotics are given concurrently.

Clinically significant anticholinergic activity may also be seen with loxapine, olanzapine, and clozapine. In addition, amoxapine is metabolized by CYP2D6. Haloperidol is an inhibitor of hepatic CYP2D6, and coadministration with amoxapine may lead to elevated amoxapine serum concentrations. Major Concurrent use of clarithromycin and haloperidol should be avoided if possible.

QT prolongation and torsade de pointes TdP have been observed during haloperidol treatment. Excessive doses particularly in the overdose setting of haloperidol may be associated with a higher risk of QT prolongation.

Because clarithromycin is also associated with an increased risk for QT prolongation and TdP, the need to coadminister clarithromycin with drugs known to prolong the QT interval should be done with a careful assessment of risks versus benefits.

Clarithromycin is an inhibitor of CYP3A4. Major Concurrent use of antipsychotics and amphetamines should generally be avoided. Antipsychotics and amphetamines may interact pharmacodynamically to diminish the therapeutic effects of either agent through opposing effects on dopamine.

Amphetamines are thought to block central dopamine reuptake, which has the potential to exacerbate psychosis, and antipsychotics, which are central dopamine antagonists, may diminish the effectiveness of amphetamines. CYP3A4 is one of the isoenzymes responsible for the metabolism of haloperidol. Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and substrates or inhibitors of CYP3A4.

Elevated haloperidol concentrations occurring through inhibition of CYP3A4 may increase the risk of adverse effects, including QT prolongation. Until more data are available, it is advisable to closely monitor for adverse events when these medications are co-administered.

A similar interaction is expected to occur between haloperidol and fosamprenavir, the prodrug of amprenavir. Moderate Administration of nitrates such as amyl nitrite to patients receiving other hypotension-producing agents, such as antipsychotics, can cause additive hypotensive or orthostatic effects. Major Torsades de pointes TdP and ventricular tachycardia have been reported during post-marketing use of anagrelide. A cardiovascular examination, including an ECG, should be obtained in all patients prior to initiating anagrelide therapy.

Monitor patients during anagrelide therapy for cardiovascular effects and evaluate as necessary. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with anagrelide include haloperidol. Angiotensin II receptor antagonists: Clinically significant interactions have been reported when doxorubicin was coadministered with inhibitors of CYP2D6, resulting in increased concentration and clinical effect of doxorubicin.

Additionally, acute cardiotoxicity can occur during the administration of doxorubicin; although, the incidence is rare. Sinus tachycardia is the most common arrhythmia, but other arrhythmias such as supraventricular tachycardia SVT , ventricular tachycardia, heart block, and premature ventricular contractions PVCs have been reported.

Haloperidol has a possible risk of causing QT prolongation and torsades de pointes TdP. Avoid coadministration of haloperidol and doxorubicin if possible.

If not possible, closely monitor for increased side effects of doxorubicin including myelosuppression and cardiotoxicity Anxiolytics; Sedatives; and Hypnotics: Moderate Haloperidol can potentiate the actions of other CNS depressants such as anxiolytics, sedatives, and hypnotics, and they should be used cautiously in combination. Moderate Monitor for decreased efficacy of haloperidol if coadministration with apalutamide is necessary.

Major Antipsychotics neuroleptics may block the dopamine agonist properties of apomorphine, thereby compromising apomorphine effectiveness. Apomorphine causes considerable somnolence, and concomitant administration of apomorphine and CNS depressants like the antipsychotics could result in additive CNS effects. Doses 6 mg SC do not provide additional clinical benefit and are not recommended. Apomorphine should be used with caution in patients receiving antipsychotics associated with QT prolongation such as haloperidol.

Careful monitoring is recommended during combined use of antipsychotics and apomorphine; dosage adjustments of one or both drugs may be warranted. Major Use caution if haloperidol and aprepitant, fosaprepitant are used concurrently and monitor for an increase in haloperidol-related adverse effects, including QT prolongation and torsade de pointes TdP , for several days after administration of a multi-day aprepitant regimen.

Haloperidol is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction.

Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Major Because both haloperidol and aripiprazole are associated with a possible risk for QT prolongation and torsade de pointes TdP , the combination should be used cautiously and with close monitoring. In addition, haloperidol is an inhibitor of CYP2D6 and aripiprazole is a partial substrate for aripiprazole.

If these agents are used in combination, the patient should be carefully monitored for aripiprazole-related adverse reactions. The risk of drowsiness, dizziness, hypotension, extrapyramidal symptoms, anticholinergic effects, neuroleptic malignant syndrome, or seizures may be increased during combined use; therefore, it may be advisable to initiate treatment with lower dosages if combination therapy is necessary.

Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone. Major If possible, drugs that are known to prolong the QT interval should be discontinued prior to initiating arsenic trioxide therapy.

QT prolongation should be expected with the administration of arsenic trioxide. Torsade de pointes TdP and complete atrioventricular block have been reported. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with arsenic trioxide include haloperidol. Major Artemether; lumefantrine is an inhibitor of and haloperidol is partially metabolized by the CYP2D6 isoenzyme; therefore, coadministration may lead to increased haloperidol concentrations.

Furthermore, although there are no studies examining the effects of artemether; lumefantrine in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation.

Concomitant use of artemether; lumefantrine with drugs that may prolong the QT interval, such as haloperidol, should be avoided. Consider ECG monitoring if haloperidol must be used with or after artemether; lumefantrine treatment. Major Use of epinephrine to treat droperidol or haloperidol -induced hypotension can result in a paradoxical lowering of blood pressure due to droperidol's alpha-blocking effects.

Avoid using epinephrine concurrently with droperidol and haloperidol. Major Asenapine has been associated with QT prolongation. According to the manufacturer, asenapine should not be used with other agents also known to have this effect e. Moderate Caution should be used in patients receiving atazanavir concurrently with drugs metabolized via CYP3A4 and known to cause QT prolongation. Atazanavir inhibits the CYP3A4 isoenzyme at clinically relevant concentrations, which may lead to increased serum concentrations of the listed drugs and an increased potential for QT prolongation or other adverse effects.

Avoid use of atazanavir with haloperidol when possible. Downward dosage adjustment of haloperidol may be necessary. Moderate Caution is warranted when cobicistat is administered with haloperidol as there is a potential for elevated haloperidol and cobicistat concentrations. Moderate Haloperidol should be used cautiously with atenolol due to the possibility of additive hypotension. Major QT prolongation has occurred during therapeutic use of atomoxetine and following overdose.

Atomoxetine is considered a drug with a possible risk of torsade de pointes TdP. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with atomoxetine include haloperidol.

Moderate Additive adverse effects resulting from cholinergic blockade may occur when hyoscyamine is administered concomitantly with haloperidol. Moderate Haloperidol can potentiate the actions of other CNS depressants, such as opiate agonists, Caution should be exercised with simultaneous use of these agents due to potential excessive CNS effects. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , cautious use of haloperidol with azithromycin is advised.

Azithromycin has been associated with post-marketing reports of QT prolongation and TdP. QT prolongation and TdP have also been observed during haloperidol treatment. Major Due to the potential for QT prolongation and torsade de pointes TdP , caution is advised when administering bedaquiline with haloperidol. Bedaquiline has been reported to prolong the QT interval.

Prior to initiating bedaquiline, obtain serum electrolyte concentrations and a baseline ECG. An ECG should also be performed at least 2, 12, and 24 weeks after starting bedaquiline therapy. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Haloperidol should be used cautiously with nadolol due to the possibility of additive hypotension. Moderate Advise patients to promptly report gastrointestinal complaints, fever, or heat intolerance when benztropine is used with drugs with either anticholinergic activity or antidopaminergic activity example is haloperidol.

Clinicians should note that anticholinergic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Additive drowsiness may also occur. Severe Bepridil administration is associated with a well-established risk of QT prolongation and torsade de pointes TdP. Patients receiving other drugs which have the potential for QT prolongation, such as haloperidol, have an increased risk of developing proarrhythmias during bepridil therapy.

According to the manufacturer, bepridil is contraindicated for use with drugs that prolong the QT interval due to the risk of TdP. Moderate Haloperidol should be used cautiously with betaxolol due to the possibility of additive hypotension. Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Major Potential QT prolongation has been reported in limited case reports with metronidazole.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include haloperidol.

Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Haloperidol should be used cautiously with bisoprolol due to the possibility of additive hypotension. Moderate Boceprevir is a substrate and inhibitor of CYP3A4, one of the isoenzymes responsible for the metabolism of haloperidol. Major Caution is advisable during concurrent use of brexpiprazole with other antipsychotics such as haloperidol. Therefore, if haloperidol is used in combination with brexpiprazole and a moderate to strong CYP3A4 inhibitor, the brexpiprazole dose should be adjusted and the patient should be carefully monitored for brexpiprazole-related adverse reactions.

The risk of drowsiness, dizziness, hypotension, extrapyramidal symptoms, anticholinergic effects, neuroleptic malignant syndrome, or seizures may be increased during combined use of haloperidol and brexpiprazole; therefore, it may be advisable to initiate treatment with lower dosages if combination therapy is deemed necessary.

Moderate Monitor for decreased efficacy of haloperidol if coadministration with brigatinib is necessary. Moderate Haloperidol should be used cautiously with timolol due to the possibility of additive hypotension. Major Avoid concurrent use of haloperidol and bromocriptine when possible. Haloperidol results in a decreased efficacy of bromocriptine. The prolactin-lowering effect of bromocriptine is antagonized; the elevation in prolactin levels produced by haloperidol persists with chronic administration.

Until more data are available, it is advisable to closely monitor for adverse events when these medications must be co-administered. Moderate Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including haloperidol or droperidol.

Therefore, caution is advisable during concurrent use of haloperidol and loop diuretics. In general, haloperidol should also be used cautiously with antihypertensive agents due to the possibility of additive hypotension. Major Due to the potential for QT prolongation and additive CNS depressant effects, cautious use and close monitoring are advisable if concurrent use of haloperidol and buprenorphine is necessary.

Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes TdP. Haloperidol has a possible risk for QT prolongation and TdP. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval.

If concurrent use of haloperidol and buprenorphine is necessary, consider a dose reduction of one or both drugs. Hypotension, profound sedation, coma, respiratory depression, or death may occur during co-administration of buprenorphine and other CNS depressants.

Prior to concurrent use of buprenorphine in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Evaluate the patient's use of alcohol or illicit drugs. Monitor patients for sedation or respiratory depression. Major Bupropion is associated with a dose-related risk of seizures. Extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as antipsychotics.

The manufacturer of bupropion recommends low initial dosing and slow dosage titration if this combination must be used; the patient should be closely monitored. In addition, bupropion and hydroxybupropion, the major active metabolite, are inhibitors of CYP2D6 in vitro. Coadministration of bupropion with medications that are metabolized by the CYP2D6 isoenzyme, such as haloperidol, should be approached with caution. Dosage reductions of haloperidol may be needed.

Conversely, if bupropion therapy is discontinued, the antipsychotic dosage may need to be increased in some patients. Moderate The combination of buspirone and CNS depressants like the antipsychotics can increase the risk for sedation.

Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and CYP3A4 substrates such as buspirone. Elevated haloperidol concentrations may increase the risk of adverse effects, including QT prolongation. Until more data are available, it is advisable to closely monitor for adverse events when buspirone is coadministered with haloperidol.

Moderate Concomitant use of butorphanol with other CNS depressants can potentiate the effects of butorphanol on respiratory depression, CNS depression, and sedation. If a CNS depressant needs to be used with butorphanol, use the smallest effective dose and the longest dosing frequency of butorphanol.

Major The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as the antipsychotic drugs. In addition, cabergoline, which is a dopamine agonist, may diminish the effectiveness of dopamine antagonists such as the antipsychotics. Major Carbamazepine may potentially accelerate the hepatic metabolism of haloperidol.

Major Antipsychotic agents may inhibit the clinical antiparkinsonian response to levodopa by blocking dopamine receptors in the brain. Haloperidol should be avoided during therapy for Parkinson's disease unless the benefit of the drug outweighs the risk of decreased therapeutic response to levodopa or other treatments.

Major COMT inhibitors should be given cautiously with other agents that cause CNS depression, including haloperidol, due to the possibility of additive sedation.

Major Avoid use of these drugs together due to duplicative therapeutic effects and additive risks for drowsiness, dizziness, orthostatic hypotension, extrapyramidal symptoms, neuroleptic malignant syndrome, and seizures.

Cariprazine, like other antipsychotics, has the potential to impair judgment, thinking, or motor skills. The use of cariprazine with other antipsychotic agents, such as haloperidol, would be expected to have additive risks for pharmacologic effects and adverse reactions.

Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during combined use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone.

Moderate Haloperidol should be used cautiously with carteolol due to the possibility of additive hypotension. Moderate Haloperidol should be used cautiously with carvedilol due to the possibility of additive hypotension.

In addition, haloperidol inhibits CYP 2D6 and may increase plasma concentrations of carvedilol. Moderate Disturbances of orthostatic regulation e. Also, based on observations in patients in a state of alcoholic delirium, high intravenous doses of clonidine may increase the arrhythmogenic potential QT prolongation, ventricular fibrillation of high intravenous doses of haloperidol.

A causal relationship and relevance for clonidine oral tablets have not been established. Major Periodically monitor electrolytes and ECGs if coadministration with haloperidol is necessary; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs.

Ceritinib causes concentration-dependent prolongation of the QT interval. QT prolongation and torsade de pointes TdP have been observed during haloperidol treatment; excessive doses particularly in the overdose setting or IV administration may be associated with a higher risk. Moderate Additive drowsiness may occur if cetirizine or levocetirizine is administered with other drugs that depress the CNS e.

Moderate Antipsychotics cause hyperprolactinemia and should not be administered concomitantly with cetrorelix since hyperprolactinemia downregulates the number of pituitary GnRH receptors. Concurrent administration of other agents metabolized through this pathway, such as haloperidol, may lead to increased cevimeline plasma concentrations. Moderate Chloramphenicol is an inhibitor of CYP3A4, one of the isoenzymes responsible for the metabolism of haloperidol.

Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and inhibitors of CYP3A4.

Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as haloperidol, with caution. Chloroquine is associated with an increased risk of QT prolongation and torsade de pointes TdP ; fatalities have been reported. The risk of QT prolongation is increased with higher chloroquine doses. QT prolongation and TdP have been observed during haloperidol treatment. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Major Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes TdP.

Other antipsychotics associated with a possible risk for QT prolongation and TdP which should be avoided during treatment with chlorpromazine include haloperidol. Coadministration may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. The likelihood of these pharmacodynamic interactions varies based upon the individual properties of the co-administered antipsychotic agent.

Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and substrates or inhibitors of CYP3A4 or CYP2D6. Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering haloperidol with ciprofloxacin. QT prolongation and TdP have been observed during haloperidol treatment, and ciprofloxacin is associated with a possible risk of QT prolongation and TdP.

Excessive haloperidol doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation. Severe Cisapride is associated with QT prolongation and torsade de pointes TdP and cisapride is contraindicated for use in patients taking other drugs known to prolong the QT interval. Both QT prolongation and TdP have been observed during haloperidol treatment. Because of the potential for torsade de pointes TdP , use of cisapride with haloperidol is contraindicated.

Major Coadministration of citalopram and haloperidol should be avoided. Citalopram causes dose-dependent QT interval prolongation, and haloperidol is associated with a possible risk for QT prolongation and torsade de pointes TdP. If concurrent therapy is considered essential, ECG monitoring is recommended.

In addition, because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering citalopram with drugs that are dopamine antagonists such as haloperidol. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes e.

Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome. In addition, citalopram mildly inhibits the CYP2D6. This can result in increased concentrations of some drugs metabolized via the same pathway, including haloperidol. Patients receiving these combinations should be monitored for the emergence of serotonin syndrome, neuroleptic malignant syndrome-like reactions, or other adverse effects.

Major A dosage reduction of CYP2D6 substrates, such as haloperidol, may be necessary during co-administration of clobazam. Limited in vivo data suggest that clobazam is an inhibitor of CYP2D6. Elevated concentrations of haloperidol occurring through inhibition of CYP2D6 may increase the risk of adverse effects, including QT prolongation and torsade de pointes.

Clobazam, a benzodiazepine, may cause drowsiness or other CNS effects which may be potentiated during concurrent use of conventional antipsychotics including phenothiazines, haloperidol, loxapine, thiothixene, or molindone. Antipsychotics may lower the seizure threshold and reduce the effectiveness of clobazam as an anticonvulsant.

Major Treatment with clozapine has been associated with QT prolongation, torsade de pointes TdP , cardiac arrest, and sudden death. Haloperidol is also associated with a possible risk for QT prolongation and TdP. In addition, coadministration may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures.

Antipsychotic drugs known to inhibit the activity of CYP2D6 include haloperidol. Elevated plasma concentrations of clozapine occurring through inhibition of CYP1A2, CYP3A4, or CYP2D6 may potentially increase the risk of life-threatening arrhythmias, sedation, anticholinergic effects, seizures, orthostasis, or other adverse effects.

According to the manufacturer, patients receiving clozapine in combination with an inhibitor of CYP2D6 should be monitored for adverse reactions. Consideration should be given to reducing the clozapine dose if necessary. If the inhibitor is discontinued after dose adjustments are made, monitor for lack of clozapine effectiveness and consider increasing the clozapine dose if necessary. Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Major Promethazine, a phenothiazine, is associated with a possible risk for QT prolongation.

Due to the risk of additive QT prolongation and potential for serious arrhythmias, promethazine should be used with caution in patients receiving haloperidol. In addition, co-administration of promethazine with haloperidol may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. Although the incidence of tardive dyskinesia from these combinations has not been established and data are very limited, the risk may be increased during combined use versus use of an antipsychotic alone.

Moderate Conivaptan is a substrate and inhibitor of CYP3A4, one of the isoenzymes responsible for the metabolism of haloperidol. Therefore, caution is advisable during concurrent use of haloperidol and corticosteroids. Topical corticosteroids are less likely to interact. Major Monitor ECGs for QT prolongation and monitor electrolytes in patients receiving crizotinib concomitantly with haloperidol; an increase in haloperidol exposure may also occur.

An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for crizotinib patients if QT prolongation occurs. Haloperidol is a CYP3A4 substrate that has been associated with QT prolongation and torsade de pointes TdP ; excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation. Major Because both cyclobenzaprine and haloperidol have a possible risk for QT prolongation and torsade de pointes TdP , this combination should be used together cautiously.

Cyclobenzaprine is structurally similar to tricyclic antidepressants, and tricyclic antidepressants have been reported to prolong the QT interval, especially when given in excessive doses or in overdosage settings. Moderate Danazol is an inhibitor of CYP3A4, one of the isoenzymes responsible for the metabolism of haloperidol.

Serum concentrations of darifenacin, a CYP2D6 substrate, may increase when used in combination with haloperidol. Patients should be monitored for increased anticholinergic side effects if these drugs are coadministered. Moderate Darunavir is a substrate and inhibitor of CYP3A4, one of the isoenzymes responsible for the metabolism of haloperidol.

Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: In addition, ritonavir also is associated with QT prolongation; concomitant use increases the risk of QT prolongation. Major Monitor for evidence of QT prolongation and torsade de pointes TdP if dasatinib and haloperidol are coadministered. In vitro studies have shown that dasatinib has the potential to prolong the QT interval.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with haloperidol include degarelix. Coadministration may result in decreased haloperidol metabolism and increased toxicity with concurrent use. Neurologic side effects have been noted clinically in some patients as a result of impaired haloperidol elimination. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with haloperidol include halogenated anesthetics.

Use caution when prescribing haloperidol concurrently with medications known to prolong the QT interval. Clinically relevant QTc prolongation may occur with deutetrabenazine. Monitor for signs and symptoms of neuroleptic malignant syndrome NMS , restlessness, and agitation. If NMS is diagnosed, immediately discontinue deutetrabenazine, and provide intensive symptomatic treatment and medical monitoring.

Recurrence of NMS has been reported with resumption of drug therapy. If akathisia or parkinsonism develops during treatment, the deutetrabenazine dose should be reduced; discontinuation may be required. Deutetrabenazine is a reversible, dopamine depleting drug and haloperidol is a dopamine antagonist.

Additionally, concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as haloperidol, may have additive effects and worsen drowsiness or sedation. Advise patients about worsened somnolence and not to drive or perform other tasks requiring mental alertness until they know how deutetrabenazine affects them.

Moderate Antipsychotics, such as haloperidol, and dexmethylphenidate may interact pharmacodynamically to diminish the therapeutic effects of either agent through opposing effects on dopamine. Dexmethylphenidate blocks central dopamine reuptake, which has the potential to exacerbate psychosis, and antipsychotics, which are central dopamine antagonists, may diminish the effectiveness of dexmethylphenidate.

Severe Quinidine should be considered contraindicated with haloperidol. QT prolongation and torsade de pointes TdP have been observed during both haloperidol and quinidine treatment. According to the manufacturer of haloperidol, caution is advisable when prescribing the drug concurrently with medications known to prolong the QT interval; however, quinidine is contraindicated for use with drugs that are CYP2D6 substrates that prolong the QT interval.

Since vast experience has accumulated with HALDOL, the adverse reactions are reported for that compound as well as for haloperidol decanoate.

As with all injectable medications, local tissue reactions have been reported with haloperidol decanoate. Tachycardia , hypotension , and hypertension have been reported. The nature of the evidence makes it impossible to determine definitively what role, if any, HALDOL played in the outcome of the reported cases. The possibility that HALDOL caused death cannot, of course, be excluded, but it is to be kept in mind that sudden and unexpected death may occur in psychotic patients when they go untreated or when they are treated with other antipsychotic drugs.

EPS can be categorized generally as Parkinson-like symptoms, akathisia , or dystonia including opisthotonos and oculogyric crisis. While all can occur at relatively low doses, they occur more frequently and with greater severity at higher doses.

The symptoms may be controlled with dose reductions or administration of antiparkinson drugs such as benztropine mesylate USP or trihexyphenidyl hydrochloride USP. It should be noted that persistent EPS have been reported; the drug may have to be discontinued in such cases. Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment.

While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups. Generally, patients receiving short-term therapy experience no problems with abrupt discontinuation of antipsychotic drugs.

However, some patients on maintenance treatment experience transient dyskinetic signs after abrupt withdrawal. In certain of these cases the dyskinetic movements are indistinguishable from the syndrome described below under "Tardive Dyskinesia" except for duration. Although the long- acting properties of haloperidol decanoate provide gradual withdrawal, it is not known whether gradual withdrawal of antipsychotic drugs will reduce the rate of occurrence of withdrawal emergent neurological signs.

Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may appear in some patients on long-term therapy with haloperidol decanoate or may occur after drug therapy has been discontinued. The risk appears to be greater in elderly patients on high-dose therapy, especially females. The symptoms are persistent and in some patients appear irreversible. The syndrome is characterized by rhythmical involuntary movements of tongue, face, mouth or jaw e.

Sometimes these may be accompanied by involuntary movements of extremities and the trunk. There is no known effective treatment for tardive dyskinesia; antiparkinson agents usually do not alleviate the symptoms of this syndrome.

It is suggested that all antipsychotic agents be discontinued if these symptoms appear. Should it be necessary to reinstitute treatment, or increase the dosage of the agent, or switch to a different antipsychotic agent, this syndrome may be masked. It has been reported that fine vermicular movement of the tongue may be an early sign of tardive dyskinesia and if the medication is stopped at that time the full syndrome may not develop.

Tardive dystonia, not associated with the above syndrome, has also been reported. Tardive dystonia is characterized by delayed onset of choreic or dystonic movements, is often persistent, and has the potential of becoming irreversible. Reports have appeared citing the occurrence of mild and usually transient leukopenia and leukocytosis , minimal decreases in red blood cell counts, anemia , or a tendency toward lymphomonocytosis.

Agranulocytosis has rarely been reported to have occurred with the use of HALDOL, and then only in association with other medication. Maculopapular and acneiform skin reactions and isolated cases of photosensitivity and loss of hair. Lactation , breast engorgement, mastalgia , menstrual irregularities, gynecomastia , impotence , increased libido , hyperglycemia , hypoglycemia and hyponatremia.

Anorexia , constipation, diarrhea , hypersalivation, dyspepsia , nausea and vomiting. Dry mouth , blurred vision , urinary retention, diaphoresis and priapism. An encephalopathic syndrome characterized 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 HALDOL.

A causal relationship between these events and the concomitant administration of lithium and HALDOL 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.

In 5 other schizophrenic patients treated with oral haloperidol and rifampin, discontinuation of rifampin produced a mean 3. Thus, careful monitoring of clinical status is warranted when rifampin is administered or discontinued in haloperidol-treated patients.

Cases of sudden death, QT-prolongation, and Torsades de Pointes have been reported in patients receiving haloperidol. Higher than recommended doses of any formulation and intravenous administration of haloperidol appear to be associated with a higher risk of QT-prolongation and Torsades 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 syndrome consisting of potentially irreversible, involuntary , dyskinetic movements may develop in patients treated with antipsychotic drugs. 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.

Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown. Both the risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase.

However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment, itself, however, may suppress or partially suppress the signs and symptoms of the syndrome and thereby may possibly mask the underlying process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.

Given these considerations, antipsychotic drugs should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that 1 is known to respond to antipsychotic drugs, and 2 for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought.

The need for continued treatment should be reassessed periodically. If signs and symptoms of tardive dyskinesia appear in a patient on antipsychotics, drug discontinuation should be considered.

However, some patients may require treatment despite the presence of the syndrome. Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may appear in some patients on long-term therapy with haloperidol decanoate or may occur after drug therapy has been discontinued. The risk appears to be greater in elderly patients on high-dose therapy, especially females. The symptoms are persistent and in some patients appear irreversible.

The syndrome is characterized by rhythmical involuntary movements of tongue, face, mouth or jaw e. Sometimes these may be accompanied by involuntary movements of extremities and the trunk. There is no known effective treatment for tardive dyskinesia; antiparkinson agents usually do not alleviate the symptoms of this syndrome.

It is suggested that all antipsychotic agents be discontinued if these symptoms appear. Should it be necessary to reinstitute treatment, or increase the dosage of the agent, or switch to a different antipsychotic agent, this syndrome may be masked.

It has been reported that fine vermicular movement of the tongue may be an early sign of tardive dyskinesia and if the medication is stopped at that time the full syndrome may not develop. Tardive dystonia, not associated with the above syndrome, has also been reported. Tardive dystonia is characterized by delayed onset of choreic or dystonic movements, is often persistent, and has the potential of becoming irreversible.

Reports have appeared citing the occurrence of mild and usually transient leukopenia and leukocytosis , minimal decreases in red blood cell counts, anemia , or a tendency toward lymphomonocytosis. Agranulocytosis has rarely been reported to have occurred with the use of HALDOL, and then only in association with other medication.

Maculopapular and acneiform skin reactions and isolated cases of photosensitivity and loss of hair. Lactation , breast engorgement, mastalgia , menstrual irregularities, gynecomastia , impotence , increased libido , hyperglycemia , hypoglycemia and hyponatremia. Anorexia , constipation, diarrhea , hypersalivation, dyspepsia , nausea and vomiting. Dry mouth , blurred vision , urinary retention, diaphoresis and priapism.

An encephalopathic syndrome characterized 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 HALDOL.

A causal relationship between these events and the concomitant administration of lithium and HALDOL 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. In 5 other schizophrenic patients treated with oral haloperidol and rifampin, discontinuation of rifampin produced a mean 3.

Thus, careful monitoring of clinical status is warranted when rifampin is administered or discontinued in haloperidol-treated patients. Cases of sudden death, QT-prolongation, and Torsades de Pointes have been reported in patients receiving haloperidol. Higher than recommended doses of any formulation and intravenous administration of haloperidol appear to be associated with a higher risk of QT-prolongation and Torsades 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 syndrome consisting of potentially irreversible, involuntary , dyskinetic movements may develop in patients treated with antipsychotic drugs. 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.

Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown. Both the risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase.

However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment, itself, however, may suppress or partially suppress the signs and symptoms of the syndrome and thereby may possibly mask the underlying process.

The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown. Given these considerations, antipsychotic drugs should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia.

Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that 1 is known to respond to antipsychotic drugs, and 2 for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically.

If signs and symptoms of tardive dyskinesia appear in a patient on antipsychotics, drug discontinuation should be considered. However, some patients may require treatment despite the presence of the 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 signs may include elevated creatine phosphokinase, myoglobinuria rhabdomyolysis and acute renal failure. The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis , it is important to identify cases where the clinical presentation includes both serious medical illness e.

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system CNS pathology.

The management of NMS should include 1 immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2 intensive symptomatic treatment and medical monitoring, and 3 treatment of any concomitant serious medical problems for which specific treatments are available.

There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS. If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported.

A number of cases of bronchopneumonia, some fatal, have followed the use of antipsychotic drugs, including HALDOL haloperidol. It has been postulated that lethargy and decreased sensation of thirst due to central inhibition may lead to dehydration , hemoconcentration and reduced pulmonary ventilation. Therefore, if the above signs and symptoms appear, especially in the elderly, the physician should institute remedial therapy promptly.

Should hypotension occur and a vasopressor be required, epinephrine should not be used since HALDOL haloperidol may block its vasopressor activity, and paradoxical further lowering of the blood pressure may occur.

Instead, metaraminol, phenylephrine or norepinephrine should be used. If indicated, adequate anticonvulsant therapy should be concomitantly maintained.

Iamges: haldol decanoate storage

haldol decanoate storage

However, hepatic impairment may have significant effects on the pharmacokinetics of haloperidol because it is extensively metabolised in the liver. Major Due to the potential for QT prolongation and additive CNS depressant effects, cautious use and close monitoring are advisable if concurrent use of haloperidol and buprenorphine is necessary. Moderate Gefitinib is an inhibitor of CYP2D6, the primary isoenzyme responsible for the metabolism of haloperidol.

haldol decanoate storage

Lower initial doses and slower titration are advisable; however, specific guidelines are not available. Administration of haloperidol decanoate as a depot intramuscular injection results in a slow and sustained release of free haloperidol.

haldol decanoate storage

Severe adverse CNS reactions induced by haloperidol may appear similar to neurologic haldol decanoate storage of CNS disorders such as encephalitis, Reye's syndrome, storagf, meningitis, and tetanus. According to the manufacturer of haloperidol, caution is advisable when prescribing the drug concurrently with medications known to haldol decanoate storage the QT interval, including alfuzosin. Depending on the clinical status of the patient, the first oral dose should be given within 12 to 24 hours following the last intramuscular dose. Print this page Add to My Med List. Although decanozte for TdP has not been established for flecainide, patients receiving concurrent haldol decanoate storage which have the potential for QT prolongation deca homes clark review have an increased risk of developing proarrhythmias.