compared 14 delirious patients who received intravenous haloperidol and benzodiazepine to 4 patients who received IV haloperidol alone, . Opiates are the medication of choice for the control of pain and dyspnea, which are common symptoms in the dying process. That said certain studies did compare the active drug with placebo [48-50], though they were in the minority. Before The most common finding is that all drugs used in practice for rapid tranquilization do, in fact, exert a calming effect and reduce agitation, and aggression, while being associated with significant side effects. The purpose of this review is to examine the evidence regarding empirical options, evaluate potential novel agents suitable for rapid tranquilization and provide vital information regarding these in a manner conducive to wise clinical decision- making. Rethinking IV haloperidol orders - Today's Hospitalist Introduction: In a number of in vivo studies, intravenous administration of haloperidol in some animal models has caused significant QTc prolongation at doses around 0.3 mg/kg, producing Cmax plasma levels at least 7 to 14 times higher than the therapeutic plasma concentrations of 1 to 10 ng/ml that were effective in the majority of patients in clinical studies. Preskorn SH. If only part of the contents of an ampoule is used, the remaining solution should be discarded. The therapeutic endpoint of rapid tranquilization is a matter of debate and in clinical practice, three different approaches are common [2-3]. Increased haloperidol plasma concentrations may result in an increased risk of adverse events, including QTc-prolongation (see section 4.4). Thus, they may exert a therapeutic action in psychotic states with a relatively lower risk of extrapyramidal side effects. We found no evidence to suggest that higher dosages were more effective in decreasing the duration of agitation or the length of hospital stay. Aripiprazole (intramuscular) for psychosis-induced aggression or agitation (rapid tranquillisation) Ostinelli EG, Jajawi S, Spyridi S, Sayal K, Jayaram MB. Single or combination prophylaxis in patients at moderate to high risk of postoperative nausea and vomiting, when other medicinal products are ineffective or not tolerated. The best way to achieve rapid tranquilization has yet to be elucidated, as there are many available drugs which differ as to their exact effects, their route of administration, their duration of action as well as their side- effect profile. The .gov means its official. J Clin Psychopharmacol. Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. The final approach, which is also the most suitable for contemporary clinical practice, is to administer drugs at the lowest possible dose which calms the patient and leads to resolution of behavioral symptoms, if possible without inducing sedation or sleep [2-3]. The FDA extended warning for intravenous haloperidol and torsades de pointes: how should institutions respond? 2018 Dec 27;379(26):2506-2516. doi: 10.1056/NEJMoa1808217. 2012 Jul 1;35(7):547-53. doi: 10.2165/11599960-000000000-00000. A naturalistic comparison study of the efficacy and safety of intramuscular olanzapine, intramuscular haloperidol, and intramuscular levomepromazine in acute agitated patients with schizophrenia. Rasmussen SA, Rosebush PI, Mazurek MF. The practice of treating agitation on an acute care basis is also referred to as rapid tranquilization. Nobay F, Simon BC, Levitt MA, Dresden GM. Haloperidol Dosage Guide + Max Dose, Adjustments - Drugs.com Continuous infusion of haloperidol controls agitation in critically ill patients. sharing sensitive information, make sure youre on a federal Sodium valproate is known to inhibit glucuronidation, but does not affect haloperidol plasma concentrations. 2009 Mar;66(3):954-8. doi: 10.1097/TA.0b013e31818e90ed. Unlike other sedative drugs (including less potent antipsychotics) it does not cause respiratory depression. Unable to load your collection due to an error, Unable to load your delegates due to an error. bepridil, methadone). As a precautionary measure, it is preferable to avoid the use of haloperidol during pregnancy. For comatose patients, a patent airway must be established by use of an oropharyngeal airway or endotracheal tube. In most prospective studies, IVH did not cause greater QT prolongation than placebo, and rates of TdP with IVH appear to be low. An IM formulation of aripiprazole has been approved for the treatment of acute agitation. Another option is zuclopenthixol acetate, another high potency typical agent. It is recommended that patients who take haloperidol concomitantly with such medicinal products be monitored for signs or symptoms of increased or prolonged pharmacologic effects of haloperidol, and the haloperidol dose be decreased as deemed necessary. The drugs are always administered orally in an outpatient setting. The main metabolic pathways of haloperidol in humans include glucuronidation, ketone reduction, oxidative N-dealkylation and formation of pyridinium metabolites. 77 of 196 identified manuscripts met inclusion criteria, including 34 clinical trials and 34 case reports or series. For the second part of our study, we opted to review the empirical evidence regarding the efficacy and risks of each of the aforementioned drugs, based on randomized controlled trials evaluating them in a rapid tranquilization context. The .gov means its official. Would you like email updates of new search results? However, hepatic impairment may have significant effects on the pharmacokinetics of haloperidol because it is extensively metabolised in the liver. Haloperidol is associated with extrapyramidal symptoms (which can be controlled by co-administration of promethazine) and may control agitation without inducing sedation, while benzodiazepines have a more pronounced sedating activity. Objectives: The primary outcome was to determine whether low-dose injectable haloperidol (0.5 mg) was similar in effect to higher doses by assessing the need for repeat doses within 4 hours as a surrogate marker. 2010;12(1):PCC.09r00938. Critical Care and Hospital Pharmacy Resources for Hospital Pharmacists, PGY-1 Pharmacy Residents, PharmD students, and Preceptors, January 23, 2023 by Pharmacy Joe Leave a Comment. The safety of haloperidol was evaluated in 284 haloperidol-treated patients who participated in 3 placebo-controlled clinical studies and in 1295 haloperidol-treated patients who participated in 16 double-blind active comparator-controlled clinical studies. The influence of hepatic impairment on the pharmacokinetics of haloperidol has not been evaluated. Antagonism of the effect of the anticoagulant phenindione has been reported. Olanzapine is a powerful sedative with its effects lasting up to 24 hours. Patients aged 65 years and older with acute agitated delirium were included. The recommended initial intramuscular or intravenous dose is 0.5 to 1 mg. Class III antiarrhythmics (e.g. The clinician should adjust the dose to the clinical course, and IV doses can . Kurlan R, Cummings J, Raman R, Thal L. Intramuscular ziprasidone versus haloperidol for managing agitation in Chinese patients with schizophrenia. 2009;13(3):R75. Antipsychotic therapy in patients with hyperthyroidism must be used only with caution and must always be accompanied by therapy to achieve a euthyroid state. The cytochrome P450 enzyme system is also involved, particularly CYP3A4 and, to a lesser extent, CYP2D6. Haloperidol can increase the CNS depression produced by alcohol or CNS-depressant medicinal products, including hypnotics, sedatives or strong analgesics. Acute treatment of delirium when non-pharmacological treatments have failed. Careers, Unable to load your collection due to an error. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone [Article in English, Portuguese] Baldacara L, Sanches M, Cordeiro DC, Jackoswski AP. Haldol (haloperidol) dose, indications, adverse effects, interactions Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Usual Adult Dose for: Psychosis Schizophrenia Agitated State Agitation Tourette's Syndrome Usual Geriatric Dose for: Schizophrenia Usual Pediatric Dose for: Psychosis Tourette's Syndrome Agitated State Aggressive Behavior Additional dosage information: Renal Dose Adjustments Liver Dose Adjustments Dose Adjustments Precautions Dialysis There is considerable variation from patient to patient in the amount of medication required for treatment. A total of 261 charts of patients who received haloperidol were reviewed and 56 patients met inclusion criteria (14 males, 42 females). Haloperidol Combination treatment of postoperative nausea and vomiting when other medicinal products are ineffective or not tolerated. The activity on the basal ganglia probably underlies the undesirable extrapyramidal motor effects (dystonia, akathisia and parkinsonism). Treatment is supportive. The authors discuss pharmacokinetic data that suggests lower doses of haloperidol should achieve higher plasma concentrations in elderly patients. Higher than recommended initial doses of haloperidol were frequently used in the treatment of delirium with acute agitation in hospitalized older people. CYP2D6 inhibitors bupropion, chlorpromazine, duloxetine, paroxetine, promethazine, sertraline, venlafaxine. Despite its widespread use, there is remarkably little clinical evidence for the benefits of lorazepam in acute agitation. To get access to my free download area with 20 different resources to help hospital pharmacists in their practice go topharmacyjoe.com/free. There is a high inter-subject variability for plasma protein binding. doi: 10.5812/aapm-132904. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. 2021 Nov 28;9(12):1785. doi: 10.3390/biomedicines9121785. Akathisia is another severe side effect which manifests either as an inability to sit still or as a subjective feeling of restlessness. The adverse reactions are presented by System Organ Class and in order of decreasing seriousness within each frequency category. An initial dose of more than 1 mg was received by 37.5 % of the patients. Clinical trials evaluating the efficacy of different treatment options have been conducted but they are extremely heterogenous and most have numerous methodological flaws, leading to a poor overall quality of evidence upon which guidelines for the appropriate treatment could be based. tremor, rigidity, hypersalivation, bradykinesia, akathisia, acute dystonia). Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, Douglas IS, Malhotra A, Owens RL, Feinstein DJ, Khan B, Pisani MA, Hyzy RC, Schmidt GA, Schweickert WD, Hite RD, Bowton DL, Masica AL, Thompson JL, Chandrasekhar R, Pun BT, Strength C, Boehm LM, Jackson JC, Pandharipande PP, Brummel NE, Hughes CG, Patel MB, Stollings JL, Bernard GR, Dittus RS, Ely EW; MIND-USA Investigators. -, Arch Gen Psychiatry. 2010 Apr;5(4):E8-16. Haloperidol is not approved for the treatment of patients with dementia-related psychosis. Consequently, it is recommended that newborn infants be monitored carefully. The site is secure. Some degree of sedation or impairment of alertness may occur, particularly with higher doses and at the start of treatment and may be potentiated by alcohol. Extrapyramidal symptoms can occur within the therapeutic range, although the frequency is usually higher with doses producing higher than therapeutic concentrations. Rapid tranquilization: a comparative study of thiothixene and haloperidol. Another concern is that its partial agonist activity, combined with its high affinity for D2 receptors may render subsequent administration of other antipsychotics ineffective by displacing them from the receptor (Table (Table11). Neurocrit Care. Because of the high haloperidol distribution volume and its high protein binding, only very small amounts are removed by dialysis. If the initial tranquilization regimen is successful, the patient can be followed up with a regular psychiatric assessment [2-3]. Unauthorized use of these marks is strictly prohibited. Diazepam may also be administered orally or IM, but IM administration has been associated with erratic absorption patterns and pain at the injection site. Treatment choice for rapid tranquilization is dependent on a number of factors, including the patients presentation, the availability of drugs in a certain setting and the desired effect. Haloperidol must be used with caution in patients with risk factors for stroke. The decision is usually made based on availability and the clinicians experience, with the typical antipsychotic haloperidol (alone or in combination with antihistaminergic and anticholinergic drugs such as promethazine), the benzodiazepines lorazepam, diazepam and midazolam as well as a variety of atypical antipsychotics being used for this purpose. These compounds are potent a1 antagonists and cause significant hypotension in patients who have not developed tolerance. The https:// ensures that you are connecting to the Seeing as the effects are unlikely to be dose-dependent, this practice is no longer supported. However, there have been isolated case reports of birth defects following foetal exposure to haloperidol, mostly in combination with other medicinal products. Animal studies have shown reproductive toxicity (see section 5.3). Conclusions: Haloperidol crosses the blood-brain barrier easily. An extrapyramidal reaction is manifest by muscular rigidity and a generalised or localised tremor. 2022 Dec 8;14(24):6047. doi: 10.3390/cancers14246047. haloperidol: Dosing, contraindications, side effects, and pill pictures From postmarketing experience with haloperidol and haloperidol decanoate. Intravenous Olanzapine for the Management of Agitation: Review of the Before During the 90-day intervention period, the patients in the haloperidol group received a median daily dose of 8.3 mg (1.7 ml) of haloperidol for a median of 3.6 days, and the patients in the . The influence of hepatic impairment on the pharmacokinetics of haloperidol has not been evaluated. Before Conduction disturbances associated with administration of butyrophenone antipsychotics in the critically ill: a review of the literature. Isolated cases of liver function abnormalities or hepatitis, most often cholestatic, have been reported (see section 4.8). This site needs JavaScript to work properly. It urges doctors to reconsider their medication choice or the drug's delivery route. 2003 Feb;51(2):234-9 Onset of action is approximately 15 minutes and the total duration of action is 8-12 hours, with 2-4 mg being a typical dose [19-20]. and transmitted securely. Haloperidol is excreted in human milk. This site needs JavaScript to work properly. The manifestations of haloperidol overdose are an exaggeration of the known pharmacological effects and adverse reactions. It has been evaluated for the treatment of agitation in patients with delirium or dementia, though this practice remains controversial [39-40]. It is unclear whether anticholinergics are effective for the resolution of akathisia, as it may be more likely to respond to benzodiazepines or beta-blockers [11]. Treatment Options for Acute Agitation in Psychiatric Patients Your email address will not be published. Of these, only olanzapine and ziprasidone are available as parenteral formulations. Continued use of this site indicates your agreement with the terms and privacy policy. Acute dystonia may occur during the first few days of treatment with haloperidol, but later onset as well as onset after dose increases has been reported. Measurement of haloperidol blood concentrations may be considered in individual cases. Not due to severely reduced level of arousal (i.e., coma). Small amounts of haloperidol have been detected in plasma and urine of breast-fed newborns of mothers treated with haloperidol. Compared to haloperidol, it has a longer duration of action (48-72 hours) and a longer and less predictable onset. Following intramuscular administration, haloperidol is completely absorbed. Suitable drugs include typical antipsychotics (often co-administered with an anticholinergic agent to reduce the incidence of side effects [4], benzodiazepines and, most recently, atypical antipsychotic drugs. Based on pooled safety data from these clinical studies, the most commonly reported adverse reactions were: extrapyramidal disorder (34%), insomnia (19%), agitation (15%), hyperkinesia (13%), headache (12%), psychotic disorder (9%), depression (8%), weight increased (8%), tremor (8%), hypertonia (7%), orthostatic hypotension (7%), dystonia (6%) and somnolence (5%). Cochrane Database Syst Rev. Hypertension rather than hypotension is also possible. Despite it being a first-generation antipsychotic, there are numerous advantages that favor using haloperidol instead of the newer atypical agents in certain circumstances. doi: 10.4088/PCC.09r00938yel. Haloperidol (and the associated droperidol) is most likely to cause extrapyramidal effects, while olanzapine and the benzodiazepines are associated with greater sedation (Table (Table22). National Library of Medicine Lehmann HE, Hanrahan GE. Etiological and therapeutic implications of the PCP/NMDA model of schizophrenia. In a carcinogenicity study of haloperidol, dose-dependent increases in pituitary gland adenomas and mammary gland carcinomas were seen in female mice. sharing sensitive information, make sure youre on a federal Antipsychotic medication utilization in nonpsychiatric hospitalizations. At present, it remains unclear whether the practice is ethical, legally allowed and under which conditions it is indicated. Table 1: Haloperidol dose recommendations for adults aged 18 years and above, Rapid control of severe acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder when oral therapy is not appropriate. Treatment should be started at the lowest possible dose, and the dose should be adjusted in increments at 2- to 4-hour intervals if agitation continues, up to a maximum of 10 mg/day. 2-10 mg initially, depending on degree of agitation; if response inadequate, may repeat bolus q15-30min, sequentially doubling initial bolus dose; when calm achieved, administer 25% of last bolus dose q6hr; taper dose after patient is controlled . Haloperidol suppresses delusions and hallucinations as a direct consequence of blocking dopaminergic signalling in the mesolimbic pathway. Haloperidol dosing strategies in the treatment of delirium in the critically ill. halofantrine). Atypical antipsychotic-induced mania/hypomania: a review of recent case reports and clinical studies. Use of high-dose intravenous haloperidol in the treatment of agitated Since haloperidol is extensively metabolised in the liver, it is recommended to halve the initial dose. The https:// ensures that you are connecting to the Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. The heterogeneity of the literature seems to preclude a comprehensive systematic review evaluating the empirical evidence pertinent to all the available drugs. Thyroxin may facilitate Haloperidol toxicity. For these reasons, it is vital that all clinicians are well- aware of the available options, the side effects associated with each and the empirical data regarding their use in such a setting. Start typing to retrieve search suggestions. Lin J, Figuerado Y, Montgomery A, Lee J, Cannis M, Norton VC, Calvo R, Sikand H. Am J Emerg Med. After withdrawal of the CYP3A4 inducer, the concentration of haloperidol may gradually increase and therefore it may be necessary to reduce the haloperidol dose. FOIA Lorazepam is generally preferred as it has a more predictable onset and duration of action, while also lacking active metabolites. Has an angel shown the way? Haloperidol is purported to induce a state of tranquility without causing significant sedation or cognitive dysfunction, similar to other high- potency typical antipsychotic drugs. Inhibition of these routes of metabolism by another medicinal product or a decrease in CYP2D6 enzyme activity may result in increased haloperidol concentrations. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. Meyer-Massetti C, Cheng CM, Sharpe BA, Meier CR, Guglielmo BJ. Store in the original carton in order to protect from light. This association may be stronger for haloperidol than for atypical antipsychotic medicinal products, is most pronounced in the first 30 days after the start of treatment and persists for at least 6 months. Bethesda, MD 20894, Web Policies Adverse reaction frequencies are based on (or estimated from) clinical trials or epidemiology studies with haloperidol, and classified using the following convention: cannot be estimated form the available data. and transmitted securely. Please enable it to take advantage of the complete set of features! The use of haloperidol has been associated with the development of akathisia, characterised by a subjectively unpleasant or distressing restlessness and need to move, often accompanied by an inability to sit or stand still. It has an unusual side effect profile as well, as it virtually never induces parkinsonism or dystonia, but can cause akathisia at rates similar to haloperidol. Do not disregard or avoid professional medical advice due to content published within Cureus. This is most likely to occur within the first few weeks of treatment. Amenorrhoea; Dysmenorrhoea; Galactorrhoea; Breast Discomfort; Breast Pain; Menorrhagia; Menstrual Disorder; Sexual Dysfunction, General disorders and administration site conditions. Continue typing to refine. Accessibility Curr Psychiatry Rep. 2007 Feb;9(1):26-34. doi: 10.1007/s11920-007-0006-x. Jones B, Taylor CC, Meehan K. A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania. Subscribe to the #1 ranked critical care and hospital pharmacy podcast. Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation) Ostinelli EG, Brooke-Powney MJ, Li X, Adams CE. Newborn infants exposed to antipsychotics (including haloperidol) during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms that may vary in severity and duration following delivery. Combination treatment of postoperative nausea and vomiting when other medicinal products are ineffective or not tolerated. Thus, the regimen to be evaluated is usually compared to the standard of care, which is 2.5-5 mg of haloperidol IM. 8600 Rockville Pike Monitoring Editor: Alexander Muacevic and John R Adler. Translational Modeling in Schizophrenia: Predicting Human Dopamine D2 Receptor Occupancy. When suggestions are available use up and down arrows to review and ENTER to select. Any unused medicinal product or waste material should be disposed of in accordance with local requirements. Useful for rapid resolution of violent agitation (rap id onset of action) iv. Non-clinical data reveal no special hazards for humans based on conventional studies of repeat dose toxicity and genotoxicity. Annals of Pharmacotherapy a retrospective single center cohort study that looked at low, medium, and high doses of parenteral haloperidol in elderly agitated patients, A Pharmacists Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies, Episode 834: Expectations for the onset of action of IM medications used for acute agitation, Episode 833: Three tips for inpatient medical emergencies, Episode 832: Savings realized by the redistribution of short-dated emergency medications, A Pharmacist's Guide to Inpatient Medical Emergencies. However, if administered intravenously, continuous ECG monitoring must be performed for QTc interval prolongation and for ventricular arrhythmias. Methods: eCollection 2023. Intravenous haloperidol: A systematic review of side effects and Dialysis is not recommended in the treatment of overdose because it removes only very small amounts of haloperidol (see section 5.2). Please fill out this brief <5 minute survey to guide WikEM's development of pediatric emergency resources: https://redcapynh.ynhh.org/surveys/?s=Y7J7DDHRTNNLFFPX, This page was last edited 20:08, 12 May 2022 by, https://redcapynh.ynhh.org/surveys/?s=Y7J7DDHRTNNLFFPX, https://www.wikem.org/w/index.php?title=Haloperidol&oldid=351343, 5-10mg IM, subsequent doses based on patient response dosed every 1 hour, 0.5-10mg IV, depending on degree of agitation; may repeat bolus dose (with sequential doubling of initial bolus dose) q15-30mins until calm achieved, 0.5-2mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day, Injectable safety and effectiveness not established in pediatric patients <12yo, 3-12yo - 0.05-0.15mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day, >12 - 0.5mg-2mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day, 3-12yo - 0.05-0.075mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day, >12 - 0.5mg-5mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day, 3-12yo - 0.01-0.03mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day, >12 - 0.5mg-10mg PO divided BID-TID, Max 100mg/day, Metabolism: Hepatic - Glucuronidation and CYP3A4-mediated, Mechanism of Action: blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain, depressing depresses the release of hypothalamic and hypophyseal hormones leading to a depressed reticular activating system. Numerous clinical trials have been conducted, utilizing both the oldest available drugs (haloperidol and benzodiazepines) as well as the more recent ones (atypical antipsychotics) [34,41-43]. Though not approved by the United States Food and Drug Administration, intravenous haloperidol (IVH) is widely used off-label to manage agitation and psychosis in patients with delirium in the hospital setting. mortality risk in elderly pts on antipsychotic tx for dementia-related psychosis; most deaths due to cardiovascular or infectious events Adult Dosing . When administered orally, the effects are noticeable within an hour, while 10-15 minutes are required for the onset of action after IM administration. Medicinal forms Related treatment summaries Other drugs in class Indications and dose Prophylaxis of postoperative nausea and vomiting [in patients at moderate to high risk and when alternatives ineffective or not tolerated] By intramuscular injection Adult 1-2 mg, to be given at induction or 30 minutes before the end of anaesthesia. Bookshelf 1 to 2 mg intramuscularly, at induction or 30 minutes before the end of anaesthesia. In some animal studies, higher intravenous haloperidol doses of 1 mg/kg or greater caused QTc prolongation and/or ventricular arrhythmias at Cmax plasma levels at least 38 to 137 times higher than the therapeutic plasma concentrations that were effective in the majority of patients in clinical studies. official website and that any information you provide is encrypted The alert warns that IV haloperidol is contraindicated for those patients because of QT-prolongation risk. Asong GM, Voshavar C, Amissah F, Bricker B, Lamango NS, Ablordeppey SY. PDF Management of Pain, Agitation and Delirium The 3 atypical antipsychotics approved for rapid tranquilization differ greatly in regards to their side effects, overall tolerability, and duration of action. Comprehensive systematic reviews are available for benzodiazepines [23] (including trials of different drugs of this class), haloperidol [10], droperidol (a haloperidol analog with a shorter duration of action used mostly in anesthesia) [44], the combination of haloperidol and promethazine [4] and the atypical antipsychotics olanzapine [45], risperidone [46] and aripiprazole [47]. toremifene, vandetanib). Haloperidol has a moderate influence on the ability to drive and use machines. Peak plasma concentrations of haloperidol are attained within 20 to 40 minutes. The mean age of subjects was 83 years. There is no specific antidote. Its effects have been thoroughly documented in the literature. Veser FH, Veser BD, McMullan JT, Zealberg J, Currier GW.