Neurologic disorders in pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Rarely, abnormal movements known as choreas appear during gestation, typically following the first trimester known as chorea gravidarum. The chorea is generally seen only on half of the body and is known as a hemichorea. The incidence is said to be 1:139,000 pregnancies (76). It was previously associated with rheumatic fever; however, in the United States, the virtual elimination of this disorder has made this association less likely. More often now, it is linked to systemic lupus erythematosus or anti-phospholipid antibody syndrome (77,78). The chorea typically resolves spontaneously, often after delivery. Rarely, the movements are so severe as to induce rhabdomyolysis and hyperthermia (79). Treatment is typically by using dopamine receptor blockers. Due to concerns involving the fetus, haloperidol is preferred since of all of the medications available, it is the least likely to cause harm (80). Similar choreiform movements may occur following institution of birth control pills as well. These typically resolve after discontinuation of OC pills.
Gilles de la Tourette’s syndrome
David Enoch, Basant K. Puri, Hadrian Ball in Uncommon Psychiatric Syndromes, 2020
Ever since their introduction for the treatment of this condition in 1961, the butyrophenones have been the mainstay of the drug treatment approach. They have been demonstrated to be effective, so that in a large number of patients symptoms disappeared, in both recent and long-standing cases (Connell et al., 1967; Boris, 1968; Fernando, 1976). Children seem to tolerate the drug well (Connell et al., 1967). The period of time necessary for haloperidol to work varies from 24 hours to 30 days or more, and the necessary dose varies from patient to patient. The drug needs to be taken regularly, and at least two years of symptom-free existence is advised before any dosage reduction is undertaken. If there is a recurrence of symptoms, then the drug should be recommenced and the dose adjusted according to the severity of the symptoms. Sometimes tolerance to the drug develops, a phenomenon that can be counteracted by alternating haloperidol with another antipsychotic (see below). Yet another hazard is the possible development of subtle changes in personality coincidental with the relief of symptoms. For example, one patient lost her creative ability, while another was so frightened of her subjective feelings as to prefer her symptoms to the overall effect of the drug.
Antipsychotics: Predicting Response/Maximizing Efficacy
Mark S. Gold, R. Bruce Lydiard, John S. Carman in Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
As-needed (prn) orders for additional antipsychotic medication up to every hour (5 to 10 mg. p.o. or 5 mg i.m.) for emergency use. Similarly, a prn order for antiparkinson medication (1 to 2 mg benztropine or 25 to 50 mg diphenhydramine i.m.) in case of acute dystonia should be written. If minimal antipsychotic effects occur after 24 hr, the dosage may be increased by 50% daily or 2 to 3 days until an effective maintenance dosage is reached. Usually the required dosage will be 20 to 60 mg of haloperidol per day, but may range as high as 100 mg/day in some patients. Compliance may be maximized by using elixirs or liquid concentrations for initial oral administration, since some patients may sequester tablets in their mouths and later discard them. If, at higher dosages (80 to 100 mg of haloperidol) no antipsychotic effects are apparent, and no extrapyramidal side effects have emerged, a blood level should be obtained to assure that adequate intestinal absorption has occurred.
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Andrea E. Cavanna
Among the first-generation antidopaminergic medications, haloperidol was the first agent that proved effective for the treatment of tics back in the 1960s. As well as being a potent dopamine antagonist of the dopamine D2 receptors, haloperidol blocks both muscarinic receptors and adrenergic receptors. Its effectiveness in tic reduction is well established [39]. However, haloperidol is also notoriously associated with dose-dependent adverse effects, particularly sedation, apathy, anhedonia, hyperprolactinemia, and extrapyramidal symptoms [22]. As a consequence, the use of haloperidol for the treatment of TS has progressively decreased over the last few decades from being a first-line agent to being used only in selected cases who are characterized by severe tics that failed to respond to other interventions [28,29].
Pharmacological management of cannabinoid hyperemesis syndrome: an update of the clinical literature
Published in Expert Opinion on Pharmacotherapy, 2022
Guillermo Burillo-Putze, John R. Richards, Consuelo Rodríguez-Jiménez, Alejandro Sanchez-Agüera
Haloperidol is a butyrophenone antipsychotic primarily used in psychiatry. However, it is also an effective antiemetic from its antagonism of chemoreceptor trigger zone dopaminergic D2 receptors [114]. Several cases of resolution of acute CHS symptoms after administration of haloperidol, at intravenous and intramuscular doses between 2.5 and 5 mg, have been reported [115,116]. Another mechanism could be tied to haloperidol’s sedative properties, which counter excessive sympathetic nervous system stimulation [64,65]. Haloperidol injection is not FDA-approved for intravenous administration. Although it is recommended to be administered intramuscularly, if given intravenously, an ECG should be monitored for QT prolongation and arrhythmias. However, in the systematic review by Beach et al., no clear evidence was found to suggest that intravenous application carries greater risk for QT prolongation or torsades de pointes than other antipsychotics [117].
Dosing antipsychotics in special populations of patients with schizophrenia: severe psychotic agitation, first psychotic episode and elderly patients
Published in Expert Opinion on Pharmacotherapy, 2021
Fayçal Mouaffak, Florian Ferreri, Julie Bourgin-Duchesnay, Emmanuelle Baloche, Olivier Blin, Pierre Vandel, Ricardo P. Garay, Pierre Vidailhet, Emmanuelle Corruble, Pierre-Michel Llorca
A Cochrane review [37] analyzed 41 RCTs with IM haloperidol for schizophrenia-induced aggression or agitation. Of these, five studies compared IM haloperidol with placebo [38–42]. The efficacy in reducing agitation was evaluated using the Positive and Negative Syndrome Scale Excited Component scale (PANSS-EC, comprising five items: excitement, hostility, uncooperativeness, hallucinatory behavior, and poor impulse control), the Clinical Global Impression-Severity of Illness scale (CGI-S) and/or other scales. A significantly greater reduction was obtained at about two hours with IM haloperidol given at doses of: (i) 2 mg and 5 mg (given at half-hour intervals until successful control of moderate to very severe symptomatology was achieved or a maximum of four injections had been given) [41]; (ii) 7.5 mg (1–3 injections/24 hrs) [38,42]; (iii) 6.5 mg (1–3 injections/24 hrs) [39]; and (iv) 7.5 mg [40] (Table 2). A significant proportion of patients treated with haloperidol were asleep at two hours and experienced dystonia [37,39,40] (Table 2). The combination of haloperidol with the H1-antagonist promethazine makes the calming effect significantly faster [37].
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