Drug Notebook

FDA Alerts

Special Alerts:

[Posted 06/16/2008] FDA notified healthcare professionals that both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis. In April 2005, FDA notified healthcare professionals that patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death. Since issuing that notification, FDA has reviewed additional information that indicates the risk is also associated with conventional antipsychotics. Antipsychotics are not indicated for the treatment of dementia-related psychosis. The prescribing information for all antipsychotic drugs will now include the same information about this risk in a BOXED WARNING and the WARNINGS section. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Antipsychotics, http://www.fda.gov/cder/drug/InfoSheets/HCP/antipsychotics_conventional.htm and http://www.fda.gov/bbs/topics/NEWS/2008/NEW01851.html.

[Posted 09/17/2007] Johnson and Johnson and FDA informed healthcare professionals that the WARNINGS section of the prescribing information for haloperidol has been revised to include a new Cardiovascular subsection regarding cases of sudden death, QT prolongation and Torsades de Pointes(TdP) in patients treated with haloperidol, especially when given intravenously, or at doses higher than recommended. Although injectable haloperidol is only approved by the FDA for intramuscular injection, there is considerable evidence that the intravenous administration of haloperidol is a relatively common off-label clinical practice.

There are at least 28 case reports of QT prolongation and TdP, some with fatal outcome in the context of off-label intravenous haloperidol. Healthcare professionals should consider this new risk information when making individual treatment decisions for their patients. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Haloperidol and http://www.fda.gov/cder/drug/InfoSheets/HCP/haloperidol.htm.

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haloperidol
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(hal oh PER i doll)

Stability

Storage

Oral

Solution

Tight, light-resistant containers at 15–30°C. Avoid freezing.

Tablets

Tight, light-resistant containers at 20–25°C.

Parenteral

Injection

Haloperidol decanoate: 15–30°C. Do not refrigerate or freeze. Protect from light.

Haloperidol lactate: 15–30°C. Do not freeze. Protect from light.

Compatibility

Parenteral

Haloperidol Decanoate

Incompatible with sterile water for injection or sodium chloride injection and with other aqueous injections.

Haloperidol Lactate

May be compatible with some drugs for a short period of time after mixing, but at least one manufacturer recommends that the lactate not be mixed with other drugs.

Solution Compatibility (haloperidol lactate)

Compatible
Dextrose 5% in water
Variable
Dextrose 5% in sodium chloride 0.2%
Ringer’s injection, lactated
Sodium chloride 0.45 or 0.9%

Drug Compatibility

Admixture Compatibility (haloperidol lactate)
Compatible
Buprenorphine HCl with glycopyrrolate
Ocycodone HCI

Y-site Compatibility (haloperidol lactate)
Compatible
Alcohol 10% in dextrose 5%
Amifostine
Amsacrine
Aztreonam
Bivalirudin
Cimetidine HCl
Cladribine
Dexmedetomidine HCl
Dobutamine HCl
Docetaxel
Dopamine HCl
Doxorubicin HCl liposome injection
Etoposide phosphate
Famotidine
Fenoldopam mesylate
Fentanyl citrate
Filgrastim
Fludarabine phosphate
Gemcitabine HCl
Granisetron HCl
Hetastarch in lactated electrolyte injection (Hextend)
Hydromorphone HCl
Lidocaine HCl
Linezolid
Lorazepam
Melphalan HCl
Methadone HCl
Midazolam HCl
Morphine sulfate
Nitroglycerin
Norepinephrine bitartrate
Ondansetron HCl
Oxaliplatin
Paclitaxel
Pemetrexed disodium
Phenylephrine HCl
Propofol
Quinupristin-dalfopristin
Remifentanil HCl
Sufentanil citrate
Tacrolimus
Teniposide
Theophylline
Thiotepa
Vinorelbine tartrate
Incompatible
Allopurinol sodium
Amphotericin B cholesteryl sulfate complex
Cefepime HCl
Fluconazole
Foscarnet sodium
Gallium nitrate
Heparin sodium
Lansoprazole
Piperacillin sodium–tazobactam sodium
Sargramostim
Variable
Sodium nitroprusside

Syringe Compatibility (haloperidol lactate)

Compatible
Buprenorphine HCl with glycopyrrolate
Cyclizine lactate with diamorphine HCl
Hydromorphone HCl
Lorazepam
Morphine HCl
Sufentanil citrate
Incompatible
Diphenhydramine HCl
Heparin sodium
Hydroxyzine HCl
Ketorolac tromethamine
Morphine sulfate
Variable
Benztropine mesylate
Cyclizine lactate
Diamorphine HCl
Hydromorphone HCl

Actions

  • Principal pharmacologic effects are similar to those of piperazine-derivative phenothiazines.
  • Precise mechanism of antipsychotic action is unclear, but appears to depress the CNS at the subcortical level of the brain, midbrain, and brain stem reticular formation; appears to inhibit the ascending reticular activating system of the brain stem (possibly through the caudate nucleus), thereby interrupting the impulse between the diencephalon and the cortex.
  • May antagonize actions of glutamic acid within the extrapyramidal system. Inhibition of catecholamine receptors may also be important in the mode of action; may also inhibit the reuptake of various neurotransmitters in the midbrain.
  • Appears to have strong central antidopaminergic and weak central anticholinergic activity.
  • Precise mechanism of antiemetic action is unclear, but has been shown to directly affect the chemoreceptor trigger zone (CTZ), apparently by blocking dopamine receptors in the CTZ.
  • Like other dopamine receptor antagonists (e.g., phenothiazines), may cause extrapyramidal reactions, and there appears to be a very narrow range between effective therapeutic dosage for management of acute psychotic disorders and that causing extrapyramidal symptoms.
  • Produces less sedation, hypotension, and hypothermia than chlorpromazine.

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