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Eskalith and Haloperidol Decanoate

Determining the interaction of Eskalith and Haloperidol Decanoate and the possibility of their joint administration.

Check result:
Eskalith <> Haloperidol Decanoate
Relevance: 02.09.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using haloperidol together with lithium can increase the levels of lithium and can affect the rhythm of your heart. Contact your doctor if you experience tiredness, dizziness, fainting, confusion, tremor, difficulty breathing, and an irregular heartbeat. You should also watch for weakness, fever, confusion, extrapyramidal symptoms (tremors), and changes in white blood cell counts.. You may need a dose adjustment or special test if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Haloperidol can cause dose-related prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may result in elevated risk of ventricular arrhythmias, including ventricular tachycardia and torsade de pointes, because of additive arrhythmogenic potential related to their effects on cardiac conduction. Haloperidol treatment alone has been associated with a number of reported cases of torsade de pointes and sudden death. The majority of cases involved intravenous administration or use of higher than recommended dosages. Lithium has also been reported to prolong the QT interval in some patients. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drugs involved and dosages of the drugs.

MONITOR CLOSELY: Although haloperidol and lithium have been used safely together in many patients, there have been a few reported cases of encephalopathic syndrome consisting of severe neurotoxic effects and extrapyramidal symptoms, followed by irreversible brain damage, associated with the combination. The mechanism is unknown.

MANAGEMENT: Caution is advised if haloperidol is used in combination with lithium, particularly when administered intravenously (not approved by the FDA) or at higher than recommended dosages. Large doses of both drugs should generally be avoided. Some clinicians have recommended reducing the haloperidol dosage when lithium is initiated. Patients should be followed closely for evidence of neurotoxicity, especially during the first few weeks of therapy. Therapy should be discontinued if potential signs and symptoms of encephalopathic syndrome develop, including weakness, fever, lethargy, tremulousness, confusion, extrapyramidal symptoms, leukocytosis, and elevations in serum enzymes, BUN and fasting blood sugar. In addition, patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsades de pointes such as dizziness, palpitations, or syncope.

References
  • Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SH "QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients." Lancet 355 (2000): 1048-52
  • Goldney RD, Spence ND "Safety of the combination of lithium and neuroleptic drugs." Am J Psychiatry 143 (1986): 882-4
  • Baastrup PC, Hollnagel P, Sorensen R, Schou M "Adverse reactions in treatment with lithium carbonate and haloperidol." JAMA 236 (1976): 2645-6
  • Miller F, Menninger J "Correlation of neuroleptic dose and neurotoxicity in patients given lithium and a neuroleptic." Hosp Community Psychiatry 38 (1987): 1219-21
  • Sala M, Vicentini A, Brambilla P, et al. "QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy." Ann Gen Psychiatry 4 (2005): 1
  • Liberatore MA, Robinson DS "Torsade de pointes: a mechanism for sudden death associated with neuroleptic drug therapy?" J Clin Psychopharmacol 4 (1984): 143-6
  • "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
  • Thomas CJ "Brain damage with lithium/haloperidol." Br J Psychiatry 134 (1979): 552
  • Spring G, Frankel M "New data on lithium and haloperidol incompatibility." Am J Psychiatry 138 (1981): 818-21
  • Cohen WJ, Cohen NH "Lithium carbonate, haloperidol, and irreversible brain damage." JAMA 230 (1974): 1283-7
  • "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  • Addonizio G "Rapid induction of extrapyramidal side effects with combined use of lithium and neuroleptics." J Clin Psychopharmacol 5 (1985): 296-8
Eskalith

Generic Name: lithium

Brand name: Eskalith, Lithobid, Lithonate, Lithotabs, Eskalith-CR

Synonyms: n.a.

Haloperidol Decanoate

Generic Name: haloperidol

Brand name: Haldol, Haldol Decanoate

Synonyms: Haloperidol

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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