Extrapyramidal symptom haloperidol

Amisulpride is a substituted benzamide, which acts as a highly selective blocker of D2 and D3 receptors (Kerwin, 2000). As with all the other drugs, it can easily be demonstrated to be effective compared with placebo and haloperidol, with a lower extrapyramidal symptom profile (Moller et al, 1995). The strength of amisulpride lies in the quality of the evidence to show that it is effective against primary negative symptoms and affective symptoms. Two studies have shown convincing superiority for negative symptoms... 

Delusions/Psychosis. Demented patients who are acutely psychotic and agitated should be treated in much the same manner as demented patients with delirium. Low doses of a high potency conventional antipsychotic like haloperidol were once preferred. This was mainly because it can be given both orally and by injection. In recent years, the atypical antipsychotic ziprasidone, which is now also available in oral and injectable forms, has superseded haloperidol as the preferred agent when treating the acutely psychotic and agitated patient with dementia. As previously noted, ziprasidone affords the same tranquilizing benefit as haloperidol, it can now be administered via injection when necessary, and it avoids the problematic extrapyramidal symptoms of haloperidol to which patients with dementia are often keenly sensitive. 

Haloperidol decanoate (Haldol Decanoate) Antipsychotic Inj 50,100 mg/mL 25-100 mg IM q4 weel long acting. Reduce dose in elderly extrapyramidal symptoms, alpha-blocking effects, high doses may prolong QT interval. 

Extrapyramidal symptoms (EPS) Dystonic reactions develop primarily with the use of traditional antipsychotics. EPS has occurred during the administration of haloperidol and pimozide frequently, often during the first few days of treatment. Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with administration of antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, rhabdomyolysis, and acute renal failure. 

Encephalopathic syndrome - An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness, confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, blood urea nitrogen, fasting blood sugar) has occurred in a few patients treated with lithium plus an antipsychotic (haloperidol). 

Blitzstein, S.M. and Brandt, G.T. (1997) Extrapyramidal symptoms from intravenous haloperidol in the treatment of delirium. Am Psychiatry 154 1474-1475. 

The four drugs were administered by psychiatrists blinded to treatment group assignment of patients. The 14-week study consisted of an 8-week dose escalation and fixed dose and a 6-week variable-dose period. The mean dose levels (mg/day) of the four compounds after the first 8 weeks were 452 for clozapine. 20.2 for olanzapine. 8.3 for risperidone and 19.6 for haloperidol. Patients on haloperidol received prophylactic anticholinergic medication to prevent extrapyramidal symptoms, and a few other drugs were permitted to treat agitation and insomnia. 

Fluphenazine decanoate may cause more acute EPS than haloperidol decanoate due to a phenomenon known as dose dumping. Here, a small amount of depot formulation is released into the systemic circulation shortly after an injection. There may be a tendency for haloperidol to be more effective for a subset of schizophrenic symptoms, less depressogenic, and slightly less likely to exacerbate extrapyramidal symptoms. These effects, however, are not large, may not be clinically significant, and are not consistently evident in all studies. 

Decision/Solution. These initial extrapyramidal symptoms suggested the onset of tardive dyskinesia. The therapist notified the patient s physician, and drug therapy was progressively shifted from haloperidol to the atypical agent clozapine (Clozaril), 450 mg/d. The extrapyramidal symptoms gradually diminished over the next 8 weeks and ultimately disappeared. 

The neuroleptics show variable absorption after oral administration. These agents readily pass into the brain, have a large volume of distribution, bind well to plasma proteins, and are metabolized to many different substances by the P-450 system in the liver. Fluphenazine decanoate and haloperidol decanoate are slow release (up to 3 weeks) formulations of neuroleptics, administered by intramuscular injection. These drugs are increasingly used in treating outpatients and individuals who are noncompliant. However, about 30% of these patients develop extrapyramidal symptoms. The neuroleptic drugs produce some tolerance but little physical dependence. 

The synthesis and discovery of the antipsychotic effects of the piperazinyl-dibenzoazepine, clozapine (Fig. 13.1) and its launch in 1972 was an important turning point in the drug treatment of schizophrenia [1-3]. Clozapine was called an atypical antipsychotic as it did not produce side effects characteristic for compounds of the chlorpromazine- or haloperidol-type (i.e., extrapyramidal symptoms) either in animal models or in the clinic. Its use, however, became very limited when it was recognized that clozapine might cause a severe, and sometimes fatal, form of agranulocytosis. 

Phenothiazines and other psychotropic agents (e.g. prochlorperazine and haloperidol) are contraindicated because they cause extrapyramidal symptoms despite being potentially efficacious. 

Extrapyramidal symptoms have been identified at much higher rates in psychotic youths than in comparable adult populations (194). Subjects who selected because of prominent positive psychotic symptoms were randomly assigned to double-blind, parallel treatment with risperidone (mean age 15 years mean dose at termination 4 mg n = 19), olanzapine (mean age, 14.6 years mean dose at termination, 12.3 mg n = 16) or haloperidol (mean age 15 years mean dose at termination 5 mg n = 15) for 8 weeks in all, 88% of those who took olanzapine, 74% of those who took risperidone, and 53% of those who took... 

There have been reports of neuroleptic malignant syndrome precipitated by promethazine 100 mg/day to treat neuroleptic drug-induced extrapyramidal symptoms and lorazepam 6 mg/day to treat agitation (349), after the addition of intramuscular haloperidol 23 mg to atypical neuroleptic drugs (350), and in other instances in children and adolescents (351). 

Heck AH, Haffmans PM, de Groot IW, Hoencamp E. Risperidone versus haloperidol in psychotic patients with disturbing neuroleptic-induced extrapyramidal symptoms a double-blind, multi-center trial. Schizophr Res 2000 46(2-3) 97-105. 

A 28-year-old woman simultaneously developed four types of tardive extrapyramidal symptoms (dystonia, dyskinesia, choreoathetotic movements, and myoclonus) while taking haloperidol the symptoms were subsequently relieved by the use of low-dose risperidone (3 mg/day) (19). 

Several reports have suggested a higher incidence and severity of extrapyramidal symptoms during haloperidol treatment in congenitally poor metabolizers of substrates... 

The relation between extrapyramidal adverse effects and the negative symptoms of schizophrenia has been studied (83). Correlation analysis after 6 weeks of treatment showed that extrapyramidal symptoms correlated significantly in patients taking haloperidol (n = 10) but not in those taking olanzapine (n = 13). The results of... 

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