Haloperidol decanoate monograph

It should not be used concomitantly with medications known to prolong the QTc interval (. 5-HT3 antagonists , tricyclic antidepressants , citalopram , etc.) as this may lead to an increased risk of QTc interval prolongation. [16] [2] Neither should it be given concurrently with lithium (medication) as it may increase the risk of lithium toxicity and neuroleptic malignant syndrome . [4] [5] [16] It should not be given concurrently with other antipsychotics due to the potential for this to increase the risk of side effects, especially neurological side effects such as neuroleptic malignant syndrome . [4] [5] [16] It should be avoided in patients on CNS depressants such as opioids, alcohol and barbiturates. [16]

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.

An encephalopathic syndrome (characterized by weakness, lethargy , fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis , elevated serum enzymes, BUN , and fasting blood sugar) 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.

Special considerations
• Drug has few CV adverse effects and may be preferred in patients with cardiac disease.
• Dose of 2 mg is therapeutic equivalent of 100 mg chlorpromazine.
• When changing from tablets to decanoate injection, patient should initially receive 10 to 20 times the oral dose once monthly (not more than 100 mg).
• Assess patient periodically for extrapyramidal reactions and tardive dyskinesia.
• Don’t withdraw drug abruptly except when required, because abrupt withdrawal may cause severe adverse reaction. Taper dosage over several weeks.
Pediatric patients
• Safety and efficacy of drug injection in children haven’t been established, and oral drug isn’t recommended for children younger than age 3.
Geriatric patients
• Drug is especially useful for agitation related to senile dementia. Tardive dyskinesia may occur more often, especially in elderly women.
• Elderly patients usually need lower initial doses and a more gradual dosage adjustment.

Haloperidol decanoate monograph

haloperidol decanoate monograph

Special considerations
• Drug has few CV adverse effects and may be preferred in patients with cardiac disease.
• Dose of 2 mg is therapeutic equivalent of 100 mg chlorpromazine.
• When changing from tablets to decanoate injection, patient should initially receive 10 to 20 times the oral dose once monthly (not more than 100 mg).
• Assess patient periodically for extrapyramidal reactions and tardive dyskinesia.
• Don’t withdraw drug abruptly except when required, because abrupt withdrawal may cause severe adverse reaction. Taper dosage over several weeks.
Pediatric patients
• Safety and efficacy of drug injection in children haven’t been established, and oral drug isn’t recommended for children younger than age 3.
Geriatric patients
• Drug is especially useful for agitation related to senile dementia. Tardive dyskinesia may occur more often, especially in elderly women.
• Elderly patients usually need lower initial doses and a more gradual dosage adjustment.

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