Haloperidol for schizophrenia

Edgell ET, Hamilton SH, Revicki DA, et al (1998). Costs of olanzapine treatment compared with haloperidol for schizophrenia results from a randomized clinical trial. Poster presented at the 21st CINP Congress, Glasgow, July 1998. 

TABLE 5-15. Quetiapine versus placebo or haloperidol for schizophrenia acute treatment... 

Hamilton SH, Revicki DA, Edgell ET, Genduso LA, Tollefson G. Clinical and economic outcomes of olanzapine compared with haloperidol for schizophrenia. Results from a randomised clinical trial. Pharmacoeconomics 1999 15(5) 469-80. 

One of your patients comes to your clinic with complaints of insomnia. She has been stable on haloperidol for schizophrenia for the past 5 years and asks you to recommend something for sleep. Which one of the following hypnotic medications would interact with the efficacy of haloperidol in controlling her psychotic symptoms ... 

Two patients who had been taking methyldopa 1 to 1.5 g daily for hypertension, without problems, developed a dementia syndrome (cognitive disabilities, loss of memory, disorientation, etc.) within 3 days of starting to take haloperidol 6 to 8 mg daily for anxiety. The symptoms totally cleared within 72 hours of stopping the haloperidol. Another patient treated with haloperidol for schizophrenia, and methyldopa for hypertension, became very irritable and aggressive. When the methyldopa was replaced with hydrochlorothiazide, the patient s behaviour improved dramatically. ... 

K (nM) values for clozapine at D2 and Di receptors are 56 and 141 compared with 0.5 and 27 for haloperidol giving D1/D2 ratios of 2.5 and 54 for the two drugs. A relatively strong block of Di compared with D2 receptors may not be the answer for schizophrenia but it could reduce the tendency to produce dyskinesias, if this depends on Di receptor activation (see Fig. 17.2). 

A 33-year-old female patient treated with haloperidol for a history of schizophrenia is seen in the ED because of complaints of fever, stiffness, and tremor. Her temperature is 104°F, and her serum creatine kinase (CK) level is elevated. What has occurred ... 

FIGURE 58-7 The IC50 values (ordinate) are the concentrations of the antipsychotic drugs that reduce the stereospecific component of 3H-haloperidol binding by 50%. The abscissa indicates the average values (and ranges) of doses used for schizophrenia. (From Seeman, P. et al. Antipsychotic drug doses and neuroleptic/dopamine receptors. Nature 261 717-719,1976)... 

Whatever the underlying causes may be, neuroleptic medications are the most effective treatment for schizophrenia. All antipsychotic medications have some form of dopamine receptor antagonism and they are distinguished by their chemical class. The phenothiazines include chlorpromazine (Thorazine), thioridazine (Mellaril), mesoridazine (Serentil), trifluoperazine (Stelazine), fluphenazine (Prolixin), and prochlorperazine (Compazine). The thioxanthenes include chlorprohixine (Taractan) and thiothixene (Navane). Butyrophenones are represented by haloperidol (Haldol). Loxapine (Loxitane) is a dibenzoxapine, and molindone (Moban) is a dihydroindolone. 

Haloperidol is indicated for schizophrenia, severe anxiety, motor tics and intractable hiccup. It is not indicated in the treatment of parkinsonism, which may be aggravated through its use, as haloperidol tends to cause extra pyramidal symptoms. 

Quraishi S, David A. Depot haloperidol decanoate for schizophrenia. Cochrane Database Syst Rev 1999. Issue 4. 

Mr. James began haloperidol therapy for schizophrenia and within several weeks developed bradykinesia, rigidity, and tremor. Though his psychoses were well controlled, he was switched to another agent, thioridazine, which proved to be as effective as haloperidol in managing his primary condition and did not result in the undesirable symptoms. The most likely explanation for these observations is that... 

Arvanitis and Miller (129) reported a multiple fixed-dose, placebo-controlled, double-blind study of quetiapine in comparison with haloperidol and placebo in acutely exacerbated patients with chronic schizophrenia. Quetiapine was administered in five doses 75, 150, 300, 600, and 750 mg/day haloperidol was given at 12 mg/day. The study design had slightly more than 50 patients in each group. The 75-mg dose of quetiapine was clearly less efficacious than the higher doses. Doses of 150 to 750 mg/day were superior to placebo and comparable with haloperidol in reducing positive symptoms and 300 mg/day was superior to placebo and comparable with haloperidol for negative symptoms. 

Reschke RW. Parenteral haloperidol for rapid control of severe, disruptive symptoms of acute schizophrenia. Dis NervSyst 1974 35 112-115. 

Csernansky J, Okamoto A. Risperidone vs haloperidol for prevention of relapse in schizophrenia and schizoaffective disorder. Presented at the Annual Meeting of the American College of Neuropsychopharmacology, Acapulco, December 12-16,1999. 

Kahn EM, Schulz SC, Perel JM, et al. Change in haloperidol level due to carbamazepine—a complicating factor in combined medication for schizophrenia. 

Among the atypical antipsychotics, clozapine has the most convincing evidence of efficacy in children and adolescents with schizophrenia ( 166,167, 170). Kumar and colleagues (171) conducted a double-blind, randomized trial of clozapine versus haloperidol in 21 children and adolescents (mean age = 14 years) whose psychosis had been previously unresponsive to typical antipsychotics. Clozapine at a mean dose of 176 mg per day was superior to haloperidol for both positive and negative symptoms. These results are consistent with an open-label study by Remschmidt and colleagues (172). This group found that clozapine at a mean dose of 154 mg per day produced notable improvement in 27 of 36 (75%) adolescents with schizophrenia previously unresponsive to at least two trials of typical antipsychotics. 

Kane JM, Carson WH, Saha AR, Saha AR, McQuade RD, Ingenito GG, Zumbroff DL, Ali MW (2002) Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder. J Clin Psychiat 63 763-71 Kasper S, Lerman MN, McQuade RD, Saha A, Carson WH, Ali M, Archibald D, Ingenito G, Marcus R, Pigott T (2003). Efficacy and safety of aripiprazole vs. haloperidol for long-term maintenance treatment following acute relapse of schizophrenia. Int J Neuropsychopharmacol 6 325-37... 

Breier A, Hamilton SH. Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. Biol Psychiatry 1999 45(4) 403-11. 

Csernansky JG, Mahmoud R, Brenner R. Risperidone-USA-79 Study Group. A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. N Engl J Med 2002 346(l) 16-22. 

Hummer M, Kemmler G, Kurz M, Kurzthaler I, Oberbauer H, Fleischhacker WW. Sexual disturbances during clozapine and haloperidol treatment for schizophrenia. Am J Psychiatry 1999 156(4) 631-3. 

In a multicenter, double-blind, randomized, controlled trial in patients with schizophrenia or schizoaffective disorder, 159 received olanzapine (mean age 47 years) and 150 received haloperidol (mean age 46 years) they were almost exclusively men (97 % in the olanzapine group and 96 in the haloperidol group) (55). During the first 6 weeks of the 12-month trial, mean doses were 11.4 mg/day for olanzapine and 11.2 mg/day for haloperidol for the rest of the first 6 months they were 14.7 and 13.5 mg/day, and... 

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