DRUG STUDY

Generic Name: Haloperidol

Brand Name:

Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol,

Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, and Sigaperidol

Classification(s): Typical Antipsychotic

Suggested Dose:

Individualized dose depends on indication and response.

AVAILABLE FORMS:

Haloperidol: Tablets – 0.5 mg, 1 mg, 2 mg, 5mg, 10 mg, 20 mg.

Haloperidol decanoate: Injection – 50mg/ml, 100 mg/ml

Haloperidol lactate: Injection – 5mg/ml. Oral concentration: 2 mg/ml.

Ordered dose: Haloperidol 5 mg 1 amp IM now then q 12 (January 19, 2010)

Mode of Action: Unknown. A butyrophenone that probably exerts antipsychotic effects by

blocking postsynaptic dopamine receptors in the brain.

ROUTE ONSET PEAK DURATION

P.O. Unknown 3-6 hr Unknown

I.V. Unknown Unknown Unknown

I.M. Unknown 3-9 days Unknown

(decanoate)

I.M. (lactate) Unknown 10-20 min Unknown

Indications:

♂ Psychotic disorders (Adults and children older than age 12: Dosage varies for

each patient. Initially, 0.5 to 5 mg P.O. b.i.d. or t.i.d. Or, 2 to 5 mg I.M. haldol

lactate q 4 to 8 hours, although hourly administration may be needed until

control is obtained.)

♂ Chronic psychosis requiring prolong therapy (Adults: 50 to 100 mg I.M.

haloperidol decanoate q 4 weeks.)

♂ Tourette Syndrome (Adults: 0.5 to 5 mg P.O. b.i.d., t.i.d., or p.r.n.)

Contraindications:

♂ In patients hypersensitive to drug and in those with parkinsonism, coma, CNS

depression.

♂ Use cautiously in elderly and deliberated patients; in patients with history of

seizures or EEG abnormalities, severe CV disorders, allergies, glaucoma, or

urine retention; and in those and those taking anticonvulsants anticoagulants,

antiparkinsonians, or lithium.

Drug Interaction:

Drug – Drug

♂ Anticholinergics: May increase anticholinergic effect and glaucoma. Azole antifungals,

buspirone, macrolides: May increase haloperidol level. Carbamazepine: May increase

haloperidol level. CNS depressants: May increase CNS depression. Lithium: May cause

lethargy and confusion after high doses. Methyldopa: May cause dementia. Rifampin:

May decrease haloperidol level.

Drug – Lifestyle

♂ Alcohol use: May increase CNS depression.

Side Effects:

♂ CNS: severe extrapyramidal reactions, tardive dyskinesia, sedation, drowsiness, lethargy,

headache, insomnia, confusion, vertigo.

♂ CV: tachycardia, hypotension, hypertension, ECG changes

♂ EENT: blurred vision.

♂ GI: dry mouth, anorexia, constipation, diarrhea, nausea, vomiting, dyspepsia.

♂ GU: urine retention, menstrual irregularities, priapism.

♂ Hematologic: leukocytosis.

♂ Hepatic: Jaundice.

♂ Skin: rash, other skin reactions, diaphoresis.

♂ Other: gynecomastia.

Adverse Effects:

♂ CNS: seizures and neuroleptic malignant syndrome.

♂ CV: torsades de pointes, with I.V. use.

♂ Hematologic: Leukopenia

Nursing Responsibilities:

♂ Although drug is least sedating of the antipsychotics, warn patient to avoid activities that

require alertness and good coordination until effects of the drugs are known.

♂ Educate patient that drowsiness and dizziness usually subside after a few weeks.

♂ Inform patient to avoid alcohol while taking this drug.

♂ Tell patient to relieve dry mouth with sugarless gum or hard candy.

♂ Always remember, don’t give deconate form IV.

♂ Monitor the client for signs of tardive dyskinesia which may occur after prolonged use. It

may not appear until months or years later and may disappear spontaneously or persist for

life, despite ending drug.

♂ Watch out for signs and symptoms of neuroleptic malignant syndrome, which is rare but

fatal.

♂ Inform patient to do not withdraw the drug abruptly unless required by severe adverse re-

actions.

♂ Remind patient to always protect the drug from light. Slight yellowing injection or con-

centrate is common and doesn’t affect potency. Discard the drug if there is a markedly

discolorations in the solutions.

♂ Stop taking haloperidol and check the patient with their doctor right away if they have

any of the following symptoms while using haloperidol: convulsions (seizures); difficulty

with breathing; a fast heartbeat; a high fever; high or low blood pressure; increased

sweating; loss of bladder control; severe muscle stiffness; unusually pale skin; or tired-

ness. These could be symptoms of a serious condition called neuroleptic malignant syn-

drome (NMS).

BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott

Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition.

Generic Name: Flupentixol

Brand Name: Fluanxol; Depixol; Depixol Low Volume; Depixol-Conc

Classification(s): Typical Antipsychotics

Ordered dose: Flupentixol decanoate 20 mg 1 amp now then q monthly (January

19, 2010)

Mode of Action: Flupenthixol is a type of thioxanthene drug and acts by antagonism of D1

and D2 dopamine receptors (as well as serotonin). Side effects are similar

to many other typical antipsychotics, namely extrapyramidal symptoms

of akathisia, parkinsonian tremor and rigidity. However, anticholinergic

adverse effects are low.

The typical antipsychotics are less commonly used now that

the atypical antipsychotics are available (with less side effects).

Indications:

♂ Schizophrenia and other psychoses

Dose: oral (rarely used) - initially 3-9mg twice daily, max. dose 18mg/day

Depot antipsychotic (Depixol) (brand name: Fluanxol Depot in Australia)

o test dose of 20mg IM,

o if tolerated, further dose of 20-40mg after 7 days,

o usual interval 2-4 weeks between doses,

o usual maintenance dose between 50mg every 4 weeks and 300mg every 2 weeks,

o max. 400mg IM weekly.

♂ Depression

Dose:

o initially 1mg/day, increased after 1 week to 2mg/day,

o use half above doses in the elderly,

o max 3mg/day (2mg in the elderly),

o doses above 2mg (1mg in the elderly) should be gived as divided doses.

Contraindications:

♂ If patient is allergic to flupentixol or any other medicine of this class.

♂ If patient is allergic to any other medicine including preservative and dyes.

♂ Elderly people should be prescribed flupentixol with caution.

♂ If patient has history of kidney problem, liver problem or epilepsy.

♂ If patient has a problem of heart disease, high blood pressure or diabetes.

♂ If patient has a problem of enlarged prostate, thyroid problem or Parkinson’s disease.

♂  If two drugs are taken together, they may interact with each other. If patient is taking

any prescribed or non-prescribed, food supplements or herbal medicine.

♂ If patient is pregnant, or plan to become pregnant.

Drug Interaction:

♂ Prescription and nonprescription medications, especially those that may cause

drowsiness such as: sedatives, narcotic pain relievers (e.g., codeine), anti-anxiety

agents (e.g., diazepam), antidepressants or other psychiatric medicine, dopamine-type

drugs (e.g., cabergoline, pergolide, bromocriptine, pramipexole), muscle relaxants

(e.g., cyclobenzaprine), drowsiness-causing antihistamines (e.g., diphenhydramine),

atropine-like drugs, anti- seizure drugs.

♂ Many cough-and-cold products contain ingredients that may add a drowsiness effect.

Side Effects:

Nausea, drowsiness, dizziness, diarrhea, constipation, blurred vision, insomnia, urine

problem, tremor, weakness, vomiting, and difficulty in breathing, slow heart rate, ir-

regular blood pressure and convulsions.

Less common side effects of flupentixol include skin rashes, muscle problem, dizzi-

ness while rising from bed, sore throat, dark urine, increased sweating, yellowness of

skin and eyes, decreased sex drive and painful erection, chest pain and muscle

spasms.

Nursing Responsibilities:

♂ Educate patient that Flupentixol can cause drowsiness, dizziness and blurred vision. 

♂ Remind client that alcohol will increase feelings of drowsiness.

♂ Remind patient that before having any surgery, including dental or emergency treat-

ment, tell the surgeon, doctor or dentist that you are taking flupentixol.

♂ Inform client that Flupentixol can occasionally cause a dry mouth. If patient experi-

ences this, try chewing sugar-free gum, sucking sugar-free sweets or pieces of ice.

♂ Flupentixol can cause some people's skin to become more sensitive to sunlight than it

usually is. Avoid strong sunlight and sunbeds until you know how your skin reacts

and use a suncream higher than factor 15.

♂ If client experience 'flu like' symptoms such as stiffness, high temperature, abnormal

paleness, leaking bladder and a racing heartbeat contact their doctor or go to the acci-

dent and emergency department of your local hospital immediately.

♂ Educate the patient that the symptoms of overdose may include seizers, muscle

spasms, weakness, fast heartbeat, fever, difficult breathing, severe dizziness, drowsi-

ness, convulsions, irregular heartbeat, disturbed concentration, constipation and

coma.

♂ Inform patient to take the medicine with a full glass of water.

♂ Remind the patient that the medicine can be taken with or without food.

♂ Instruct to the patient that he can swallow the medicine as whole. Don’t cut or chew

the medicine.

BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott

Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition.

Generic Name: Biperiden

Brand Name: Akineton, Benzum 2, Berofin, Biperen, Bipiden, Desiperiden

Classification(s): Anti-Parkinson's Agent, Anticholinergic

Suggested Dose:

Adults:

Parkinsonism: 2 mg 3-4 times/day

Extrapyramidal: 2 mg 1-3 times/day

Elderly: Initial: 2 mg 1-2 times/day

Ordered dose: Biperiden Hcl 2 mg / tab 1 tab B.I.D. prn for EPS (January 19,

2010)

Mode of Action: Biperiden is a weak peripheral anticholinergic agent with nicotinolytic

activity. The beneficial effects in Parkinson's disease and neuroleptic-

induced extrapyramidal symptoms are believed to be due to the inhibition

of striatal cholinergic receptors.

Indications:

♂ Adjunctive treatment of all forms of Parkinson's disease (postencephalitic, idiopathic, and

arteriosclerotic).

♂ Improve parkinsonian signs and symptoms related to antipsychotic drug therapy.

♂ Relieves muscle rigidity, reduces abnormal sweating and salivation, improves abnormal

gait, and to lesser extent, tremor.

Contraindications:

♂ Hypersensitivity to biperiden or any component of the formulation

♂ Narrow-angle glaucoma

♂ Bowel obstruction, megacolon

♂ Myasthenia gravis

♂ Caution in patients with obstructive diseases of the urogenital tract, patients with a known

history of seizures and those with potentially dangerous tachycardia.

Drug Interaction:

Drug – Drug

♂ Amantadine, rimantadine: Central and/or peripheral anticholinergic syndrome can occur

when administered with amantadine or rimantadine.

♂ Anticholinergic agents: Central and/or peripheral anticholinergic syndrome can occur

when administered with opioid analgesics, phenothiazines and other antipsychotics (espe-

cially with high anticholinergic activity), tricyclic antidepressants, quinidine and some

other antiarrhythmics, and antihistamines.

♂ Atenolol: Anticholinergics may increase the bioavailability of atenolol (and possibly

other beta-blockers); monitor for increased effect.

♂ Cholinergic agents: Anticholinergics may antagonize the therapeutic effect of cholinergic

agents; includes tacrine and donepezil.

♂ Digoxin: Anticholinergics may decrease gastric degradation and increase the amount of

digoxin absorbed by delaying gastric emptying.

♂ Levodopa: Anticholinergics may increase gastric degradation and decrease the amount of

levodopa absorbed by delaying gastric emptying.

♂ Neuroleptics: Anticholinergics may antagonize the therapeutic effects of neuroleptics.

Side Effects:

♂ CNS : Drowsiness, vertigo, headache, and dizziness are frequent. With high doses

nervousness, agitation, anxiety, delirium, and confusion. Biperiden may lower the

seizure-threshold.

♂ Peripheral side effects : Blurred vision, dry mouth, impaired sweating, abdominal dis-

comfort, and obstipation are frequent. Tachycardia may be noted. Allergic skin reactions

may occur.

♂ Eyes : Biperiden causes mydriasis with or without photophobia. It may precipitate narrow

angle glaucoma.

Adverse Effects:

♂ Cardiovascular: Orthostatic hypotension, bradycardia

♂ Central nervous system: Drowsiness, euphoria, disorientation, agitation, sleep disorder

(decreased REM sleep and increased REM latency)

♂ Gastrointestinal: Constipation, xerostomia, dry throat, nasal dryness

♂ Genitourinary: Urinary retention

♂ Neuromuscular & skeletal: Choreic movements

♂ Ocular: Blurred vision

Nursing Responsibilities:

♂ Instruct patient to use caution when driving, operating machinery, or performing

other hazardous activities. Biperiden may cause dizziness or blurred vision. If patient

experience dizziness or blurred vision, avoid these activities.

♂ Remind patient to use alcohol cautiously. Alcohol may increase drowsiness and

dizziness while client is taking biperiden.

♂ Remind client to avoid becoming overheated. Biperiden may cause decreased

sweating. This could lead to heat stroke in hot weather or with vigorous exercise.

♂ Educate client to take each dose with a full glass of water.

♂ Educate patient to take biperiden after a meal if it upsets his stomach.

♂ Remind the patient to store biperiden at room temperature away from moisture and

heat.

♂ This medication decreases saliva production, an effect that can increase gum and

tooth problems (e.g., cavities, gum disease). Instruct client to take special care with

their dental hygiene (e.g., brushing, flossing) and have regular dental check-ups.

♂ If client experiences signs of hyperthermia such as mental/mood changes, headache,

or dizziness, promptly seek cool or air-conditioned shelter and/or stop exercising, and

seek immediate medical attention.

♂ Remind patient to not share the medication to others.

♂ If patient misses a dose, remind them to take it as soon as they remember. If it is near

the time of the next dose, skip the missed dose and resume their usual dosing

schedule. Do not double the dose to catch up.

BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott

Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition

Generic Name: Chlorpromazine Hydrochloride

Brand Name: Chlorpromanyl, Largactil, Novo-Chlorpromazin, Thorazine

Classification(s): Typical Antipsychotic

Suggested Dose:

Individualized dose depends on indication and response.

AVAILABLE FORMS:

Capsules (extended release): 200 mg, 300 mg.

Injections: 25 mg/ml

Oral concentrate: 30 mg/ml, 100 mg/ml

Suppositories: 25 mg, 100 mg

Syrup: 10 mg/5ml

Tablets: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg

Ordered dose: Chlorpromazine 200g/tab (January 20, 2010)

Mode of Action: Unknown. A piperidine phenothiazine that probably blocks postsynaptic

dopamine receptors in the brain.

ROUTE ONSET PEAK DURATION

P.O. 30-60min Unknown 4-6hr

I.M., I.V. Unknown Unknown Unknown

P.R. >1hr Unknown 3-4 hr

Indications:

♂ Psychosis, mania (Adults: for hospitalized patients with acute disease, 25 mg

I.M.)

♂ Nausea and vomiting (Adults: 10 to 25 mg PO q 4 to 6 hours, p.r.n. Or, 25 mg

IM initially.)

♂ Acute intermittent porphyria, intractable hiccups (Adults: 25 to 50 mg PO

t.i.d. or q.i.d.)

♂ Tetanus (Adults: 25 to 50 mg IV or IM t.i.d. or q.i.d.)

Contraindications:

♂ In patients hypersensitive to drug; in those with CNS depression, bone mar-

row suppression, or subcortical damage, and in those in coma.

♂ Use cautiously in elderly and deliberated patients and in patients with hepatic

or renal disease, severe CV disease, respiratory disorders, hypocalcemia, glau-

coma, pr prostatic hyperplasia.

♂ Use cautiously in acutely ill or dehydrated children.

Drug Interaction:

Drug – Drug

♂ Antacids: May inhibit absorption of oral phenothiazines. Anticholinergics such as

tricyclic antidepressants, antiparkinsonians: May increase anticholinergic activity,

aggravated parkinsonian symptoms. Anticonvulsants: May lower seizure threshold.

Barbiturates, lithium: May decrease phenothiazine effect. Centrally acting anthypertensives:

May decrease antihypertensive effect. CSN depressants: May increase CNS depression.

Electroconvulsive therapy, insulin: may cause severe reactions. Lithium: May increase

neurologic effects. Meperidine: May cause excessive sedation and hypotension. Propanolol:

May increase levels of both propanolol and chlorpromazine. Warfarin: May decrease effect

of oral anticoagulants.

Drug – Lifestyle

♂ Alcohol use: May increase CNS depression, particularly psychomotor skills.

Side Effects:

♂ CNS: extra pyramidal reactions, sedation, tardive dyskinesia, pseudoparkinsonism.

♂ CV: orthostatic hypotension

♂ GI: dry mouth, constipation

♂ GU: urine retention

♂ Skin: mild photosensitivity reactions, pain at IM injection site

Adverse Effects:

♂ CNS: Seizures and neuroleptic malignant syndrome.

♂ Hematologic: Leukopenia, agranulocytosis, aplastic anemia, thrombocytopenia

Nursing Responsibilities:

♂ Obtain baseline blood pressure measurements before starting therapy, and monitor

regularly. Watch client for orthostatic hypotension.

♂ Monitor client for tardive dyskinesia, which may occur after prolonged use.

♂ Warn patient to avoid activities that require alertness or good coordination until effects of

drug are known.

♂ Remind client that drowsiness and dizziness usually subside after a few weeks.

♂ Advise patient not to crush, chew, or break extended release capsule form before

swallowing.

♂ Educate patient to avoid alcohol while taking the drug.

♂ Have the patient to report signs of urine retention or constipation.

♂ Remind patient to use sunblock and to wear protective clothing to avoid oversensitivity to

the sun.

♂ Advise client to relieve dry mouth with sugarless gum or hard candy.

♂ Withhold dose and notify prescriber if jaundice, symptoms of blood dyscrasia, or

persistent extrapyramidal reactions develop.