NMS clinically manifests as muscle rigidity, hyperpyrexia, altered mental status (including catatonic signs), and evidence of autonomic instability (tachycardia, irregular pulse or blood pressure, diaphoresis, and cardiac arrhythmias). Health care providers should reassess the need for continued treatment periodically, and if any signs of TD appear, discontinuation of haloperidol should be considered. In patients when chronic treatment is required, clinicians should recommend the smallest possible dose and the shortest treatment duration of treatment, generating a reasonable clinical response. Chronic antipsychotic medicine should generally be reserved for patients with chronic illness when it is known to respond to those antipsychotic medicines and for patients for whom alternative or equally effective and potentially less toxic treatments are unavailable or inappropriate. Hence, antipsychotic drugs, including haloperidol, should be prescribed in a way that is most likely to minimize the occurrence of TD. Although rarely, TD can develop after relatively short treatment periods and low doses. The risk of developing TD and being irreversible is proportional to treatment duration and total cumulative dose for antipsychotic medicine. Hence exercise caution when used in patients with increased risk for cerebrovascular adverse reactions.Ī syndrome consisting of involuntary, irreversible, and dyskinetic movements may develop in patients administered antipsychotic drugs. Īntipsychotic use is associated with an increased risk of transient ischemic attack, stroke, and death, in elderly patients with dementia-related psychosis. Special care should be taken in patients with electrolyte imbalances (particularly hypokalemia or hypomagnesemia), hypothyroidism, underlying cardiac abnormalities, concomitant drugs known to increase QTc and familial long QT-syndrome. Intravenous administration or higher than recommended doses of any haloperidol formulation is associated with a higher risk of QTc interval-prolongation, Torsades de Pointes, and sudden death. Hence haloperidol is not FDA-approved for the treatment of patients with dementia-related psychosis. In seventeen placebo-controlled controlled trials, patients using atypical antipsychotic drugs for 10-weeks, death was reported in 4.5% of patients for drug-treated patients compared to 2.6% in the placebo group. There is an increased risk of mortality (1.6 to 1.7 times) in elderly patients with dementia-related psychosis. Since many drugs (barbiturates, benzodiazepines, and opioids) can cause depression in CNS, concurrent use of haloperidol should be avoided or used with great caution. Haloperidol is contraindicated if there is documented hypersensitivity to this drug, patients with Parkinson disease, dementia with Lewy body, comatose patients, in any condition with a severely depressed central nervous system (CNS).
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