Makindo Medical Notes

⚠️ Use reduced doses in elderly and frail patients.
🚫 Avoid in: Lewy body dementia, Parkinsonism, prolonged QTc >470 ms, acute alcohol withdrawal, epilepsy.
💡 Non-drug strategies first: orient the patient (well-lit room, visible clock), involve family, reassurance.

📘 About

• Haloperidol is a typical antipsychotic (neuroleptic).
• Main uses: acute confusion (delirium), acute psychosis, mania, severe agitation, nausea/vomiting.

⚙️ Mode of Action

• Dopamine D₂ receptor antagonist in mesolimbic pathways.
• Reduces positive psychotic symptoms, agitation, and vomiting reflex (chemoreceptor trigger zone).
• But also blocks nigrostriatal dopamine → extrapyramidal side effects (EPS).

💊 Indications & Example Doses

• 🤢 Severe Nausea/Vomiting: 1–2 mg IM.
• 🧓 Agitation in elderly (delirium): 0.5–1.5 mg PO/IM every 8–12h.
• 🌀 Acute Psychosis/Mania: 0.5–3 mg PO/IM tds (max 20 mg/day).
• 😟 Severe Anxiety (short-term): 0.5 mg PO every 8–12h.
• 🚨 Severely Disturbed Patients: 2–10 mg PO/IM initially, titrate up to 18 mg/day.

⚠️ Always check ECG (QTc) before initiation and review renal/hepatic function.

🚫 Contraindications

• Parkinson’s disease, Lewy body dementia.
• Prolonged QTc (>470 ms), history of arrhythmia.
• Liver or renal failure.
• Epilepsy, acute alcohol withdrawal, severe depression.
• Myasthenia gravis.

⚠️ Side Effects

• 🧠 Extrapyramidal symptoms (rigidity, tremor, akathisia, dystonias).
• 🚨 Neuroleptic Malignant Syndrome (rare, life-threatening).
• 💤 Sedation, drowsiness, insomnia.
• 📉 Hypotension, dizziness, prolonged QT.
• 👁️ Glaucoma, blurred vision.
• GI upset, antimuscarinic effects (dry mouth, constipation, urinary retention).

📖 References

• BNF – Haloperidol