Haloperidol

The authors compared the efficacy and side effects of trazodone and haloperidol for treating agitated behaviors associated with dementia. Twenty-eight elderly patients with dementia and agitated behaviors were randomly assigned to double-blind treatment with either trazodone (50-250 mg/day) or haloperidol (1-5 mg/day) for 9 weeks. There was no significant difference in improvement between the medication groups. Adverse effects, however, were more common in the group treated with haloperidol. Improvement in individual areas suggested that repetitive, verbally aggressive, and oppositional behaviors responded preferentially to trazodone, whereas symptoms of excessive motor activity and unwarranted accusations responded preferentially to haloperidol. These results indicate that moderate doses of trazodone and haloperidol are equally effective for treatment of overall agitated behaviors in patients with dementia, but specific symptoms may respond preferentially to a particular agent.

In normal subjects after a single oral dose, haloperidol half-life has been reported to range - hours (or up to days). After chronic administration, half-lives of up to 21 days have been reported. The objective of this study was to evaluate specific factors that might account for differences in haloperidol half-life in patients taking haloperidol chronically, including gender, age, weight, race, CYP2D6 and CYP3A5 genotypes, comedication, and -one patients were administered haloperidol for 4 weeks followed by a 1-week washout before administration of clozapine. Haloperidol plasma levels were measured weekly for at least 2 months after discontinuation. The geometric mean for haloperidol half-life and detectable levels duration were and days, respectively. Within 31 subjects, 58% (18/31) had half-lives <3 days (- days) and 42% (13/31) had half-lives > or =3 days. Two of 3 patients with half-lives longer than 30 days (720 hours) and levels detectable >2 months had received haloperidol decanoate. Five patients who received haloperidol decanoate in the prior year were excluded from a comparison between patients with long haloperidol half-lives (> or =3 days, n = 10) and patients with short half-lives (<3 days, n = 16). The only significant difference between the two groups was that African-Americans (n = 4) were all found to have a long haloperidol half-life (P = ). CYP3A5 genotype did not appear to influence haloperidol half-life but the two CYP2D6 poor metabolizer had half-lives > or =3 days. This study suggests that haloperidol half-life following repeated drug administration is substantially more prolonged than what has been observed after acute haloperidol administration.

3 to 12 years and 15 to 40 kg:
-Initial dose: mg/day orally in 2 to 3 divided doses
-Maintenance dose: to mg/kg/day

Comments:
-The daily dose may be increased every 5 to 7 days in mg increments.
-There is little evidence that behavior improvement is further enhanced by doses greater than 6 mg/day.
-Limitation of use: Treatment should be reserved for patients with severe behavior problems and/or hyperactive children only after failure to respond to psychotherapy or medications (other than antipsychotics).

Uses:
-Treatment of severe behavior problems in children, including combative, explosive hyperexcitability not accounted for by immediate provocation
-Short-term treatment of hyperactive children with excessive motor activity and accompanying conduct disorder with impulsivity, difficulty sustaining attention, aggressiveness, mood lability, and/or poor frustration tolerance.

Haloperidol

haloperidol

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