Haloperidol chemical structureImage:Haloperidol_decanoate_chemical_structure.png
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Haloperidol

Haloperidol (sold as Aloperidin®, Bioperidolo®, Brotopon®, Dozic®, Einalon S®, Eukystol®, Haldol®, Halosten®, Keselan®, Linton®, Peluces®, Serenace®, Serenase®, Sigaperidol®) is a conventional butyrophenone antipsychotic drug. It was developed in 1957 by the Belgian company Janssen Pharmaceutica and submitted to first clinical trials in Belgium in the same year. After being rejected by U.S. company Searle due to side effects, it was later marketed in the U.S. more...

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by McNeil Laboratories.

Chemistry

Haloperidol is an odourless white to yellow crystalline powder. Its chemical name is 4--4'-fluorobutyrophenone and its empirical formula is C21H23ClFNO2

Pharmacology

Haloperidol is a neuroleptic, a butyrophenon. Due to its strong central antidopaminergic action, it is classified as a highly potent neuroleptic. It is approximately 50 times more potent than chlorpromazine on a weight basis (50mg chlorpromazine are equivalent to 1mg haloperidol). Haloperidol possesses a strong activity against delusions and hallucinations, most likely due to an effective dopaminergic receptor blockage in the mesocortex and the limbic system of the brain. Too, it blocks the dopaminergic action in the nigrostriatal pathways, which is the probable reason for the high frequency of extrapyramidal-motoric side-effects (dystonias, akathisia, pseudoparkinsonism). It has minor antihistaminic and anticholinergic properties, therefore cardiovascular and anticholinergic side-effects such as hypotension, dry mouth, constipation, etc., are seen quite infrequently, compared to less potent neuroleptics such as chlorpromazine. Haloperidol also has sedative properties and displays a strong action against psychomotor agitation, due to a specific action in the limbic system. It therefore is an effective treatment for mania and states of agitation. Additionally, it can be given as an adjuvant in the therapy of severe chronic pain.

The peripheral antidopaminergic effects of haloperidol account for its strong antiemetic activity. There, it acts at the CTZ (Chemical Trigger Zone). Haloperidol is useful to treat severe forms of nausea/emesis such as those resulting from chemotherapy. The peripheral effects lead also to a relaxation of the gastric sphincter muscle and an increased release of the hormone prolactin, with the possible emergence of breast enlargement and secretion of milk (lactation) in both sexes.

Pharmacokinetics

Oral dosing

Haloperidol is well absorbed after oral dosing. There is a first pass metabolism leading to a reduced oral biovailability of the drug (60 to 70%). Peak plasma-levels are observed after 3 to 6 hours.

I.m. injections

The drug is well and rapidly absorbed and has a high bioavailability. Plasma-levels reach their maximum within 20 minutes after injection.

I.v. injections

The bioavailability is 100% and the very rapid onset of action is seen within about ten minutes. The duration of action is 3 to 6 hours. If haloperidol is given as slow i.v.-infusion, the onset of action is retarded, but the duration prolonged compared to i.v.-injection.

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Olanzapine vs. Haloperidol for treatment of acute mania
From American Family Physician, 7/15/04 by Karl E. Miller

The typical antipsychotic agents continue to be used in the acute mania phase of patients with bipolar disorder to provide rapid control of acute mania symptoms. Recently, questions have been raised concerning the safety of these agents in patients with bipolar disorder. Many researchers have suggested that the typical antipsychotic agents may worsen the course of bipolar disorder by switching patients into depression and increasing their risk of depressive episodes and rapid cycling. These agents also have safety issues, particularly those of acute extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome. The newer, atypical antipsychotic agents have a lower risk of side effects compared with the older, typical agents. However, there is limited literature available evaluating these two classes of medications in the treatment of patients with bipolar disorder. Tohen and associates evaluated the safety and efficacy of olanzapine (an atypical antipsychotic agent) and haloperidol (a typical antipsychotic agent) in patients diagnosed with acute mania.

The trial was a 12-week, multicenter, randomized, double-blind, parallel group study of patients who met the criteria for bipolar I disorder, manic or mixed type (with or without psychotic features) in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). Participants were included if they had a mania score of 20 or higher on mania phase. Patients were assessed at baseline and randomized to receive olanzapine (5, 10, 15, or 20 mg per day) or haloperidol (3, 5, 10, or 15 mg per day). Dosages were adjusted during the study period based on the clinical judgment of the attending physician.

Participants were assessed on a weekly basis with multiple standardized surveys, including one for quality of life. Patients who showed improvement in mania score at week 6 were allowed to complete the study; patients whose score did not improve were excluded from the final six-week continuation phase of the study. Adverse events were recorded at each visit, and vital signs, weight, and clinical laboratory tests were assessed at baseline, and at weeks 6 and 12, or when the patient discontinued randomized therapy.

There were 453 participants in the study. The rates of remission of mania symptoms were not significantly different in the olanzapine group than in the haloperidol group. There was a significant increase in the risk of rapid switching to depression and a significant worsening of extrapyramidal symptoms in those receiving haloperidol compared with those receiving olanzapine. Participants were more likely to have a weight gain with olanzapine. Participants who received olanzapine had a statistically significant greater improvement on quality-of-life measurement scores. The authors conclude that olanzapine and haloperidol provide similar rates of remission in patients in the acute mania phase of bipolar disorder. They add that olanzapine does have a lower risk for extrapyramidal symptoms, but also has a higher risk of weight gain compared with haloperidol.

KARL E. MILLER, M.D.

Tohen M, et al. A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Arch Gen Psychiatry December 2003;60:1218-26.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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