Haloperidol - What is Haloperidol?

Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines.

Haloperidol is an older antipsychotic used in the treatment of schizophrenia and, more acutely, in the treatment of acute psychotic states and delirium. A long-acting decanoate ester is used as a long acting injection given every 4 weeks to people with schizophrenia or related illnesses who have a poor compliance with medication and suffer frequent relapses of illness, or to overcome the drawbacks inherent to its orally administered counterpart that burst dosage increases risk or intensity of side effects. In some countries this can be involuntary under Community Treatment Orders.

Haloperidol is sold under the tradenames Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol, Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, and Sigaperidol. In medical slang, haloperidol is occasionally called vitamin H.

Haloperidol was discovered by Paul Janssen. It was developed in 1958 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. by McNeil Laboratories. It was approved by the U.S. Food and Drug Administration on April 12, 1967.

A comprehensive review of haloperidol has found it to be an effective agent in treatment of symptoms associated with schizophrenia.

Haloperidol is also used in the control of the symptoms of:

  • Acute psychosis, such as drug psychosis (LSD, psilocybin, amphetamines, ketamine, and phencyclidine), psychosis associated with high fever or metabolic disease
  • Acute manic phases until the concomitantly given first-line drugs such as lithium or valproate are effective
  • Hyperactivity, aggression.
  • Acute delirium
  • Otherwise uncontrollable severe behavioral disorders in children and adolescents
  • Agitation and confusion associated with cerebral sclerosis
  • Adjunctive treatment of alcohol and opioid withdrawal
  • Treatment of neurological disorders such as tic disorders, Tourette syndrome, and chorea
  • Treatment of severe nausea/emesis (postoperative, side-effects of radiation and cancer chemotherapy)
  • Adjunctive treatment of severe chronic pain, always together with analgesics
  • Therapeutic trial in personality disorders such as borderline personality disorder
  • Also used in the treatment of intractable hiccups

Some weeks or even months of treatment may be needed before a remission of schizophrenia is evident.

In some clinics the use of atypical neuroleptics (e.g. clozapine, risperidone, olanzapine, ziprasidone) is generally preferred over haloperidol, because these drugs have an appreciably lower incidence of extrapyramidal side-effects. Each of these drugs, however, has its own spectrum of potentially serious side-effects (e.g. agranulocytosis with clozapine, weight gain with increased risk of diabetes and of stroke). Atypical neuroleptics are also much more expensive and have recently been the subject of increasing controversy regarding their efficacy in comparison to older products and side effects.

Haloperidol was considered indispensable for treating psychiatric emergency situations, although the newer atypical drugs have gained greater role in a number of situations as outlined in a series of consensus reviews published between 2001 and 2005. It is enrolled in the World Health Organization List of Essential Medicines.

As is common with typical neuroleptics, haloperidol is by far more active against "positive" psychotic symptoms (delusions, hallucinations etc.) than against "negative" symptoms (social withdrawal, autism etc.). With the exception of the highly effective clozapine, the effectiveness of haloperidol against positive symptoms has not been outperformed by newer antipsychotics.

A multi-year UK study by the Alzheimer's Research Trust suggested that this and other neuroleptic anti-psychotic drugs commonly given to Alzheimer's patients with mild behavioural problems often make their condition worse. The study concluded that

Controversial non-medical uses

There are multiple reports from Soviet dissidents, including medical staff, on the use of haloperidol in the Soviet Union for punitive purposes or simply to break the prisoners' will. Notable dissidents that were administered haloperidol as part of their court ordered treatment were Sergei Kovalev and Leonid Plyushch. The accounts of Plyushch in the West, after he was allowed to leave the Soviet Union in 1976, were instrumental in the triggering Western condemnation of Soviet practices at the World Psychiatric Association's 1977 meeting. The use of haloperidol in the Soviet Union's psychiatric system was prevalent because it was one of the few psychotropic drugs produced in quantity in the USSR.

Haloperidol has been used for its sedating effects during the deportations of aliens by the United States Immigration and Customs Enforcement (ICE). During 2002-2008, federal immigration personnel used haloperidol to sedate 356 deportees. By 2008, followed court challenges over the practice, haloperidol was given to only 3 detainees. Following lawsuits, U.S. officials changed the procedure so that it is done only by the recommendation of medical personnel and under court order.

Further Reading


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