Haloperidol: instruction Cautions

The subject of the study in this article is the preparation "Haloperidol", the instruction to which is taken as the basis of the material.

Haloperidol (Haloperidol), Haloperidol Decanoate (for injections), Haloperidol in droplets is by far the most potent psychotropic drug of a wide spectrum of action. He has an honorary age in the history of treatment of the most severe mental and neurological diseases - 55 years old (developed and tested in Belgium by the company "Janssen Pharmaceuticals" in 1957).

The substance belongs to the group of neuroleptics or antipsychotics. So it was called, while in the pharmacology and pharmaceutics of the 1990s there appeared no antipsychotics (antipsychotics) of the new generation. After that, haloperidol was called a typical neuroleptic (TN) or a typical antipsychotic (TA). Preparations of a new generation (for example, Seroquel, Olanzapine, etc.) were called atypical antipsychotics (AN) or atypical antipsychotics (AA). The difference between the generations of these medicines has, perhaps, a revolutionary significance in medicine. It is important to understand how dangerous is Haloperidol. The side effects that it possesses sometimes lead to additional diseases requiring separate treatment.

In some AA (Seroquel), these side effects have not yet been detected.

Haloperidol, the instruction to which is considered in this material, has a truly huge range of actions. It is enough only to list the diseases that are treated with its use, so that the most important importance that it has in medical practice becomes apparent.

Haloperidol is used in the following cases :

• Psychomotor agitation of various origins: mania (overexcitation with the commission of dangerous acts), cases of mental retardation, psychopathy (illness of cognition and behavior), schizophrenia (the most severe of known mental illnesses), chronic alcoholism;
• Delusional disorders (inability to distinguish the real world from imaginary reality);
• Hallucinatory disorders (absolute belief in delusional auditory or visual phenomena of reality, which in fact do not exist);
• Manifestation of Tourette's syndrome (twitching of facial muscles, involuntary wink, grimacing, uncontrollable foul language);
• The manifestation of Huntington's chorea (severe and dangerous violation of movements until complete loss of coordination, irreversible gradual distortion of speech and thinking, progressive brain dying, in the future - complete erasure of personality and uncontrollability of motor functions, the disease is incurable - it is possible only partial relief of suffering in the patient; In most cases, the disease ends with the death of the patient);
• The manifestation of psychosomatic abnormalities (which are not fully explained by the transferred somatic - not mental illnesses, but also not fully explained by current mental ailments);
• Behavioral disorders in children and the elderly;
• Manifestation of stuttering;
• The manifestation of persistent vomiting and persistent hiccups, which are not amenable to other types of treatment.
• For a variant of the drug, "Haloperidol Decanoate" is a supportive treatment for manifestations of schizophrenia.

Haloperidol - side effects

What side effects does haloperidol have? The instruction says this with utmost clarity.

Action on the nervous system and sensory organs:

• The phenomena of akathisia (restlessness);
• The phenomena of dystonic extrapyramidal disorders (with spasm of facial, cervical and spinal muscles, tick movements, twitching, weakness of hands and feet);
• The phenomena of parkinsonian extrapyramidal disorders (with difficulties during conversation and swallowing, with a "masky face" - the folds of the muscles and facial skin are smoothed, the facial expression does not correspond to feelings, with shuffling gait, the hand and fingers - tremor;
• Phenomena of headache, often reaching intolerable;
• Phenomena of insomnia;
• Phenomena of drowsiness (perhaps even alternating drowsiness and insomnia);
• The phenomena of anxiety, anxiety, agitation, agitation (emotion);
• Phenomena of euphoria (causeless state of unhealthy and rather long joy - while the patient does not feel happy);
• The phenomena of depression (uncaused states of depression, often - aversion to life and the desire to die);
• The phenomena of lethargy (the state of "imaginary death" - all the functions of the body imitate death, in an indefinite time all life functions return);
• Epilepsy (a disease of convulsive seizures with loss of consciousness);
• Phenomena of confused consciousness;
• Cases of exacerbation (worsening, exacerbation) of psychosis;
• Cases of hallucinations;
• The phenomenon of tardive dyskinesia (see "Necessary precautions");
• Cases of visual acuity, cataracts (opacity of the lens in the eye), retinopathy (retinal vascular disease).

Action on the cardiovascular system, on the processes of hematopoiesis:

• The phenomenon of tachycardia (rapid heartbeat);
• Cases of hypertension / hypotension (high or low blood pressure);
• Cases of ventricular arrhythmia (rhythm disturbance of heart beats);
• A picture of changes on the ECG (a bad cardiac electrocardiogram);
• Cases of sudden death of cardiovascular origin;
• Cases of transient leukopenia and leukocytosis (a decrease or increase in the number of white blood cells, indicates a weakening of the protective properties of the body, is dangerous for the onset of blood cancer);
• The phenomenon of erythropenia (a decrease in the number of red blood cells, indicates an insufficient amount of oxygen in the blood, is dangerous for the onset of blood cancer);
• Cases of anemia (lack of hemoglobin of the blood, also speaks of a deficiency of oxygen in the body, dangerous by the presence of inflammatory processes);
• The phenomenon of agranulocytosis (a decrease in the number of granulocytes - granular blood cells responsible for protecting the body from infections, is dangerous by severe inflammatory processes, the ultimate danger is the occurrence of blood cancer).

Action on the respiratory system:

• The phenomenon of laryngospasm (difficulty swallowing and speech);
• The phenomenon of bronchospasm (difficulty breathing - as with asthma).

Action on the gastrointestinal tract

• Cases of anorexia (rejection of any food through vomiting, dangerous depletion and even death from hunger);
• Cases of constipation and diarrhea;
• The phenomena of hypersalivation (unhealthy non-stop flow of saliva);
• Cases of uncontrollable nausea and vomiting;
• Cases of liver failure;
• The phenomenon of obstructive jaundice (mechanical blockage of the bile ducts).

Action on the genitourinary system

• Mammary glands are a phenomenon of roughness (coarsening);
• Cases of atypical secretion (unusual discharge) of milk;
• The phenomenon of mastalgia (pain in the mammary gland);
• The phenomenon of gynecomastia (increase in mammary glands in men);
• Menstrual cycle is broken;
• Phenomena of urine retention;
• Cases of impotence;
• Cases of unreasonable increase of sexual desire;
• Cases of priapism (prolonged erection for no apparent reason).

Action on the skin

• Cases of skin changes: maculopapular (rash consisting of spots and skin rises) and acneiform (rash consisting of acne-acne);
• The phenomena of photosensitization (severe inflammation of the skin under the influence of light);
• Cases of alopecia (hair loss).

Other side effects

• The phenomenon of malignant neuroleptic syndrome (the temperature rises above 40 degrees, the sweat breaks off, the pressure drops, the urine goes away involuntarily, the muscles "coagulate," the consciousness is lost, the appearance of a coma appears.) The causes of the condition have not been studied, treatment has not been developed.
• Cases of hyperprolactinemia (excess prolamine hormone - the cause of infertility and early termination of menstruation);
• The phenomena of hyperglycemia (elevated blood sugar) and hypoglycemia (low sugar);
• Cases of hyponatremia (low sodium in the blood, dangerous brain edema).

Patients who, despite having contraindications, were prescribed haloperidol, their relatives should discuss the situation with the attending physician and demand a replacement of the appointment, if possible.

The necessary precaution in the treatment of haloperidol

In the treatment processes, the following dangerous trends were identified:

• Older patients with psychosis associated with dementia (senile memory loss) are at risk. They have an increase in mortality. The cause is most often problems from the field of cardiovascular diseases - the phenomenon of heart failure, sudden death, pneumonia. Atypical antipsychotics, which in some cases are safer than haloperidol, in this case give the same picture of risk as TA.
• Cases of tardive dyskinesia after long reception or withdrawal of the drug (tongue, face, mouth and jaw move involuntarily - for example, the tongue protrudes, the cheeks inflate, the lips wrinkle, there are the phenomena of uncontrolled masticatory movements, involuntary limb and trunk movements). In a number of patients, tardive dyskinesia is irreversible. It is necessary to cancel the drug.
• Cases of extrapyramidal disorders (see "Side effects")
• Cases of cardiac dysfunction, including those involving sudden cardiac death.

A list of side effects and risks when using haloperidol reveals the main problem associated with the use of the drug. Haloperidol is extremely dangerous. Doctors who use it in a wide practice (mainly in psychiatry), there is a hard choice. On the one hand, it was not possible to treat these diseases without haloperidol until recently. On the other hand, its use requires extreme caution and the doctor's readiness at any time to begin additional treatment, already against the unwanted symptoms and syndromes that haloperidol itself gives. The instruction informs: at a dangerous development of side effects the drug should be canceled. But in the vast majority of cases, this is impossible, since the cancellation will lead to an exacerbation of the underlying disease.

A partial solution to the problem is given by AA - in particular, Seroquel (Quetiapine), beyond which extrapyramidal disorders and dyskinesia are not noticed, and the therapeutic effect slightly exceeds the capabilities of Haloperidol. However, to assert that AA is definitely better than TA is still early - it is necessary to continue clinical studies and practical observation.