Haldol (Haloperidol): Haldol is an acceptable antipsychotic used for the management of a number of disorders including; psychosis, nonpsychotic dementia in the elderly, Huntington's Chorea, and Tourette's syndrome. Haldol is a potent antipsychotic with fewer adverse effects, which are usually observed with other antipsychotics like Mellaril and Thorazine. These adverse effects include: confusion, agitation, memory loss, psychosis, cardiac arrhythmias, and orthostatic hypotension (dangerously low blood pressure upon standing up). Caution is advised when using Haldol to manage central nervous system (CNS) disorders like confusion and agitation in the elderly. Often, CNS disorders in the elderly result from increased drug dose or a change in the drug regimen. Sometimes fluid and electrolyte imbalances, infections, or changes in an individual's environment can lead to psychotic behavior. Often, psychotic behavior can be remedied simply by eliminating the cause, which can be a better than prescribing an antipsychotic drug.

Haldol is the preferred antipsychotic for acute episodes of agitation in people with dementia. On the other hand, Risperdal (Risperidone) is the preferred antipsychotic in the elderly for the treatment and monitoring of non-acute situations associated with dementia.

Dosing in the elderly initially begins at 0.25-0.5 mg taken once or twice daily. Doses are then increased gradually, and should not exceed 4 mg a day. Side effects include; orthostatic hypotension (dangerously low blood pressure when standing up), sedation, drowsiness, pseudoparkinsonian signs and symptoms, overflow incontinence, seizure, altered core body temperature, gastrointestinal upset, dry mouth, weight gain, sexual dysfunction, blurred vision, among others.

Haldol interacts with a number of different drugs. People should inform their doctor about all the medications they are on before using Haldol.

Special Geriatric Considerations With Antipsychotic Use

Antipsychotics can sometimes cause more problems than they are intended to treat. Therefore, routine screening (i.e. semi-annual) should be done for all people receiving antipsychotic medications. The following is a list of warnings that apply specifically to elderly people who are prescribed antipsychotic drugs:

Anticholinergic Effects: These include adverse effects on the central nervous system like confusion, agitation, memory loss, and psychotic behavior. Anticholinergic side effects occur most commonly with low potency antipsychotics like Mellaril (Thioridazine) and Thorazine (Chlorpromazine).

Cardiac Toxicity: Low potency antipsychotics may be more likely to cause cardiac arrhythmia (i.e. Mellaril). High potency antipsychotic agents may be better options (i.e. Haldol) especially in people with heart conduction defects.

Extrapyramidal Reactions: Akathisia and pseudoparkinsonism are common extrapyramidal reactions. They occur with greater frequency in people with dementia. Often these disorders are difficult to diagnose in people who are already diagnosed with dementia. Extrapyramidal reactions are most commonly seen during the first two or three months of therapy, and usually subside when the antipsychotic dose is either lowered or discontinued.

Orthostatic Hypotension: Dangerously low blood pressure while standing up (orthostatic hypotension) is common with all antipsychotics. Low potency agents (i.e. Mellaril, Thorazine, Clozaril) usually cause orthostatic hypotension with greater frequency than high potency antipsychotics.

Sedation: Antipsychotics frequently cause sedation. In no circumstance should they be used as hypnotics (sleep agents) unless insomnia is accompanied by symptoms that are treated with antipsychotics. Sedation may last for up to 24 hours, in which case daytime function may be adversely affected.

Tardive Dyskinesia: Tardive dyskinesia (impaired and uncoordinated movement) can occur with frequency as high as 40% in the elderly. Elderly women are at a significantly high risk for developing tardive dyskinesia. This disorder is sometimes irreversible unless it is diagnosed early in therapy. Whether or not tardive dyskinesia is irreversible depends primarily on the total duration of treatment and on the accumulation of dose.

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