1. Haloperidol in the Acute Setting By Philip (Scott) Wright Intern Pharmacist

2. Haloperidol(Haldol ® ) Typical High Potency Antipsychotic Typical High Potency Antipsychotic Dosage Range PO 5-80 mg/d Max 100 Dosage Range IM 2.5 mg q4-8h Indications for Trmt of Acute Psychosis Indications for Trmt of Acute Psychosis In ER, Tourette’s Syndrome, Severe Behavioral Problems(Children), Autism, decrease choreiform Mvmts in Huntington disease In ER, Tourette’s Syndrome, Severe Behavioral Problems(Children), Autism, decrease choreiform Mvmts in Huntington disease

3. Mechanism of Action (MOA) MOA Blocks postsynaptic mesolimbic dopaminergic D 1 and D 2 receptors in the brain. Blocks postsynaptic mesolimbic dopaminergic D 1 and D 2 receptors in the brain. Exhibits a strong alpha-adrenergic blocking and anticholinergic effect, also reticular activating system (RAS), thus affecting body temperature, wakefulness basal metabolism, vasomotor tone and emesis Exhibits a strong alpha-adrenergic blocking and anticholinergic effect, also reticular activating system (RAS), thus affecting body temperature, wakefulness basal metabolism, vasomotor tone and emesis Pharmacokinetic (PKA) Metabolized by liver, Half-life 20 hours, Time to Peak 20 minutes, Crosses Placenta and found in Breast Milk Metabolized by liver, Half-life 20 hours, Time to Peak 20 minutes, Crosses Placenta and found in Breast Milk Interactions CYP450 Haldol is a CYP1A2 Enzyme Substrate (Significant), thus a CYP1A2 inhibitor will significantly increase plasma concentration Haldol is a CYP1A2 Enzyme Substrate (Significant), thus a CYP1A2 inhibitor will significantly increase plasma concentration Inhibitors of (CYP1A2) so >> Levels of Haldol Inhibitors of (CYP1A2) so >> Levels of Haldol Grapefruit Juice, Paroxetine (Paxil®), Fluvoxamine (Luvox®), Cimetadine (Tagamet®),Omeprazole (Prilosec®), Ciprofloxacin (Cipro®),Norfloxacin(Noroxin®), Clarithromycin(Biaxin®), Isoniazid (INH), ketoconazole (Nizoral®)

4. Haldol In the Acute Setting Max Dose 3 days Max Dose 1 day

5. Statistical Interpretation Average 3.8 Std dev 6.19 Mode 0 Correlation Coefficient 0=0, 1=0, 2=0 Interpretation: Since the standard deviation is greater in magnitude than the mean, thus the spread about the mean indicates that Haldol is only used when appropriately needed. The medication is used not to systematically control all patients that are prescribed. Since the standard deviation is greater in magnitude than the mean, thus the spread about the mean indicates that Haldol is only used when appropriately needed. The medication is used not to systematically control all patients that are prescribed. Less than 1/2 th the maximum dosage is used by 67% 1SD of the sample population, and 9/10 th of the maximum dose in 95% 2SD of the population in 1, 3, 14 and 30day periods. Less than 1/2 th the maximum dosage is used by 67% 1SD of the sample population, and 9/10 th of the maximum dose in 95% 2SD of the population in 1, 3, 14 and 30day periods. On average 1/5 of the maximum acceptable administered medication is given at any one day, and throughout the prescribed regimen. On average 1/5 of the maximum acceptable administered medication is given at any one day, and throughout the prescribed regimen. The mode reflects on average most patients will not receive Haldol just because it is ordered. The mode reflects on average most patients will not receive Haldol just because it is ordered. The Correlation Coefficient reflects that there is no relationship between incidence, and application per patient i.e. every patient receives at least 1, 2, 3, doses. The Correlation Coefficient reflects that there is no relationship between incidence, and application per patient i.e. every patient receives at least 1, 2, 3, doses.

6. Haldol In the Acute Setting Max Dose 1 day Max Dose 3 days

7. Statistical Interpretation Average 1.5 Mode 1 Std dev 2.54 Correlation Coefficient 0=0, 1=0, 2=0 0=0, 1=0, 2=0Interpretation: Since the standard deviation is close in magnitude to the mean, but the mean is lower compared to the PO dosing indicates that Haldol IM is used less than PO and only when appropriately needed. Since the standard deviation is close in magnitude to the mean, but the mean is lower compared to the PO dosing indicates that Haldol IM is used less than PO and only when appropriately needed. Even less with IM vs. PO that 1/2 th the maximum dosage is used by 67% 1SD of the sample population, and 9/10 th of the maximum dose in 95% 2SD of the population in 1, 3, 14 and 30day periods. Even less with IM vs. PO that 1/2 th the maximum dosage is used by 67% 1SD of the sample population, and 9/10 th of the maximum dose in 95% 2SD of the population in 1, 3, 14 and 30day periods. On average 1/8 of the maximum acceptable administered medication is given at any one day, and throughout the prescribed regimen. On average 1/8 of the maximum acceptable administered medication is given at any one day, and throughout the prescribed regimen. With a mode of 1 as compared to PO, most patient will receive an IM dose. With a mode of 1 as compared to PO, most patient will receive an IM dose. Once again the Correlation Coefficient reflects that there is no relationship between incidence, and application per patient i.e. every patient receives at least 1, 2, 3, doses. Once again the Correlation Coefficient reflects that there is no relationship between incidence, and application per patient i.e. every patient receives at least 1, 2, 3, doses.

8. Comparison of PO Vs. IM Same Periods