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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Differential Effects of Haloperidol and Clozapine on Motor Recovery after Sensorimotor Cortex Injury in Rats
From Journal of Neurologic Physical Therapy, 12/1/03 by Rizzolo, Jaime

Abstracts

Differential Effects of Haloperidol and Clozapine on Motor Recovery after Sensorimotor Cortex Injury in Rats. Goldstein LB, Bullman S. Neurorebabil Neural Repair. 2002; 16:321-325.

Several previous studies in the literature examine the effects of haloperidol on post brain injury recovery. The specific purpose of this study was to compare the relative effects of haloperidol and clozapine on motor recovery after unilateral sensorimotor cortex injury in rats. The authors hypothesized that haloperidol's antagonistic effects at the noradrenergic receptors would result in a relatively negative effect on motor recovery when compared to clozapine.

One hundred forty two Male Sprague-Dawley rats were obtained from Charles River Breeding Laboratories, Inc. in Raleigh, NC and housed in a controlled environment. Each rat was expected to negotiate a 2.5cm x 122cm elevated wooden beam surrounded by associated bright lights and white noise which served as avoidance and activating stimuli. Training on the behavioral testing apparatus was performed with each rat until it consistently traversed the beam without difficulty.

Following training, groups of 16 rats underwent right sided craniotomies. Surgical control rats also underwent the identical surgical procedure, but craniotomies were not performed. The day after surgery, rats (n= 3-4 per group) were given either a single dose of saline vehicle or a single dose of haloperidol (either 0.1, 1.0, or 10.0mg/kg;intraperitoneal). In separate experiments, another group of 16 rats (n= 3-4 per group) that underwent cortex surgery received either a single dose of saline vehicle or a single dose of clozapine (0.1, 0.5, or 1.0mg/kg; intraperitoneal). The effects of these drugs on beam-walking performance in sham cortex-lesioned rats were tested in separate experiments.

Behavioral testing was performed at 1 hour intervals for 6 hours following drug administration and then daily over the subsequent 12 days by an observer blind to the study hypothesis. Motor performance was rated on an ordinal 7 point scale.

Statistical analysis of data collected was performed using repeated-measures analysis of variance (ANOVAs), post-hoc Fisher least significant difference (LSD), Kruskalis-Wallis test, and the post-hoc Dunn procedure. The final results indicated that haloperidol impaired overall motor recovery (ANOVA F[3, 42], P=0.0()2) at each tested dose (Fisher LSD P > 0.01, respectively) with no significant differences between the doses (Fisher LSD P

Based on these findings, the authors conclude that a single dose of haloperidol given the day after sensorimotor cortex injury has a long-lasting, detrimental effect of subsequent functional locomotor recovery. The effect was present even at the lowest dose tested (0.1mg/kg) and was still evident 2 weeks later. In contrast to the effects of haloperidol, there was no detrimental effect of clozapine when given at low dose (0.1mg or 0.5mg/kg), with only the highest dose group differing from controls. Although the authors acknowledge the limitations of applying the conclusions of animal studies to clinical practice, they suggest that based on the results of this study and several prior studies, the use of low doses of clozapine may provide a safer alternative to haloperidol in the treatment of agitated patients recovering from strokes.

Jaime Rizzolo, Student UMDNJ

Morriston Memorial Hospital

Copyright Neurology Report Dec 2003
Provided by ProQuest Information and Learning Company. All rights Reserved

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