Haloperidol

Haloperidol is an anti-psychotic medication that is used to treat motor and vocal tics in children with Tourette’s syndrome between 10 and 17 years of age, schizophrenia in children between 13 & 17 years and persisitent or severe aggression in children between 6 & 17 years of age with autism or pervasive development disorders.

Haloperidol does have a significant number of side effects and should be used with caution in a variety of conditions. To see the full list of contraindications please click on the summary of product characteristics.

One of the most concerning side effects are the cardiovascular effects, which are particularly common when Haloperidol is used with other medications which prolong the QTc interval. Haloperidol should not be used in combination with antibiotics such as azithromycin, clarithromycin, erythromycin, levofloxacin & moxifloxacin. Haloperidol should also be avoided with certain anti-fungals and gastrointestinal medicines.

Available safety data in the paediatric population indicate a risk of developing extrapyramidal symptoms, including tardive dyskinesia (eg tremor, rigidity, hypersalivation, bradykinesia, akathisia, acute dystonia), and sedation.

Haloperidol has been associated with neuroleptic malignant syndrome: a rare idiosyncratic response characterized by hyperthermia, generalised muscle rigidity, autonomic instability, altered consciousness and increased serum creatine phosphokinase levels. Hyperthermia is often an early sign of this syndrome. Antipsychotic treatment must be withdrawn immediately and appropriate supportive therapy and careful monitoring instituted.

QTc prolongation and/or ventricular arrhythmias, in addition to sudden death, have been reported with haloperidol. The risk of these events appears to increase with high doses, high plasma concentrations, in predisposed patients or with parenteral use, particularly intravenous administration.

Caution is advised in patients with bradycardia, cardiac disease, family history of QTc prolongation or history of heavy alcohol exposure.

A baseline ECG is recommended before treatment. During therapy, the need for ECG monitoring for QTc interval prolongation and for ventricular arrhythmias must be assessed in all patients. Whilst on therapy, it is recommended to reduce the dose if QTc is prolonged, but haloperidol must be discontinued if the QTc exceeds 500 ms.

It is recommended to review the need for continued treatment with haloperidol on a regular basis.

Full drug information is available in the summary of product characteristics