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Published online by Cambridge University Press: 06 October 2020
THERAPEUTICS
Brands
• Haldol, Haldol Decanoate, Dozic, Serenace
Generic?
• Yes
Class
• Antipsychotic
Commonly Prescribed for
(FDA approved in bold)
• Tics in Gilles de la Tourette syndrome (GTS) in adults and children
• Psychotic disorders
• Refractory severe behavioral problems in children with combative explosive hyperexcitability (oral only)
• Short-term treatment in children of excessive motor activity with conduct disorder (oral only)
• Schizophrenia (Decanoate only)
• Acute mania
• Nausea and vomiting
• Acute migraine
• Hiccup
• Delirium
• Behavioral disturbances in dementia
• Augmentation for refractory obsessivecompulsive disorder
How the Drug Works
• It is a butyrophenone derivative that exerts its function at multiple levels of the CNS
• It is a D2-4 inverse agonist (for positive symptoms), 5-HT2A antagonist (for negative symptoms), and α1A antagonist
• Due to negligible affinity for H1 and M1 receptors, it has relatively lower risk for sedation, weight gain, and orthostatic hypotension but with more dyskinesia
• Antiemetic action is probably through blocking the dopamine receptors in the chemoreceptor trigger zone
How Long Until It Works
• Psychosis: usually within a week
• GTS: weeks to months
• Acute migraine: usually within hours
If It Works
• Use at lowest effective dose
• Monitor QTc interval
• Continue to assess effect of the medication and if it is still needed
If It Doesn't Work
• Psychosis: increase dose or change to another agent
• GTS: discontinue or change to another agent
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Tics and GTS symptoms may change over time. Many patients improve with age. Behavioral and psychological therapies are useful. Education and reassurance are all that is needed in mild cases
• Indentify and treat comorbid conditions, such as ADHD or obsessive-compulsive disorder
• In GTS, α2 agonists such as clonidine, guanfacine, reserpine, and other neuroleptics are also useful
• For intractable migraine, often combined with NSAIDs or dihydroergotamine
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