DRUG STUDY

GENERIC NAME

Haloperidol

BRAND NAME Aloperidin

CLASSIFICATION Typical Antipsychotic

DOSAGE 50mg/ml, IM

MECHANISM OF A butyrophenone that probably exerts antipsychotic effects by

ACTION blocking postsynaptic dopamine receptors in the brain.

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.)

CONTRAINDICATION  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.

 In patients hypersensitive to drug and in those

with parkinsonism, coma, CNS depression.

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  Although drug is least sedating of the antipsychotics,

RESPONSIBILITY 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 reactions.

 Remind patient to always protect the drug from light.

Slight yellowing injection or concentrate 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 tiredness. These could be

symptoms of a serious condition called neuroleptic

malignant syndrome (NMS).

GENERIC NAME

Flupentixol

BRAND NAME Fluanxol

CLASSIFICATION Typical Antipsychotics

DOSAGE Flupentixol decanoate 20 mg 1 amp now then q monthly

MECHANISM OF Flupenthixol is a type of thioxanthene drug and acts by antagonism

ACTION 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.

INDICATIONS  Schizophrenia and other psychoses

 Depression

CONTRAINDICATION  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.

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, irregular blood pressure and convulsions.

 Less common side effects of flupentixol include skin

rashes, muscle problem, dizziness while rising from

bed, sore throat, dark urine, increased sweating.

ADVERSE EFFECTS  . Yellowness of skin and eyes, decreased sex drive and

painful erection, chest pain and muscle spasms.

NURSING  Educate patient that Flupentixol can cause

drowsiness, dizziness and blurred vision.
RESPONSIBILITY  Remind client that alcohol will increase feelings of
drowsiness.
 Remind patient that before having any surgery,
including dental or emergency treatment, tell the
surgeon, doctor or dentist that you are taking
flupentixol.
 Inform client that Flupentixol can occasionally
cause a dry mouth. If patient experiences 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 accident 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, drowsiness, 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.
GENERIC NAME

Chlorpromazine

Hydrochloride
BRAND NAME Chlorpromanyl

CLASSIFICATION Typical Antipsychotic

DOSAGE 30 mg/ml PO

MECHANISM OF A piperidine phenothiazine that probably blocks postsynaptic

ACTION dopamine receptors in the brain.

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.)

CONTRAINDICATION  In patients hypersensitive to drug; in those

with CNS depression, bone marrow

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, glaucoma, pr

prostatic hyperplasia.

 Use cautiously in acutely ill or dehydrated

children.

DRUG INTERACTION  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  Obtain baseline blood pressure measurements before

starting therapy, and monitor regularly. Watch client for
RESPONSIBILITY 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.