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Haloperidol Decanoate Injection and Tofranil

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

Check result:
Haloperidol Decanoate Injection <> Tofranil
Relevance: 25.08.2022 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 imipramine can affect the rhythm of your heart. Contact your doctor if you experience tiredness, dizziness, fainting, confusion, tremor, difficulty breathing, and an irregular heartbeat. Lower dosages of imipramine may be necessary when used with haloperidol. You should be advised you may also experience excessive imipramine side effects such as dry mouth, visual disturbances, urinary retention, dizziness, constipation, and seizures. 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. Tricyclic antidepressants have also been reported to prolong the QT interval and cause torsade de pointes arrhythmia, usually in overdose or in combination with other drugs that prolong the QT interval such as neuroleptic or antiarrhythmic agents. 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: Haloperidol may increase the serum concentrations of tricyclic antidepressants by inhibiting their metabolism via CYP450 2D6. There have been case reports of seizures associated with this interaction.

MANAGEMENT: Caution is advised if haloperidol is used in combination with other drugs that prolong the QT interval, particularly when administered intravenously or at higher than recommended dosages. Haloperidol is not approved by the FDA for intravenous administration. Lower dosages of the tricyclic antidepressant may be necessary when used with haloperidol. Patients should be advised to notify their physician if they experience excessive tricyclic antidepressant adverse effects such as dry mouth, visual disturbances, urinary retention, dizziness, orthostasis, constipation, and seizures. 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
  • Alter P, Tontsch D, Grimm W "Doxepin-induced torsade de pointes tachycardia." Ann Intern Med 135 (2001): 384-5
  • Strasberg B, Coelho A, Welch W, Swiryn S, Bauernfeind R, Rosen K "Doxepin induced torsade de pointes." Pacing Clin Electrophysiol 5 (1982): 873-7
  • Gram LF, Overo KF "Drug interaction: inhibitory effect of neuroleptics on metabolism of tricyclic antidepressants in man." Br Med J 1 (1972): 463-5
  • Nelson JC, Jatlow PI "Neuroleptic effect on desipramine steady-state plasma concentrations." Am J Psychiatry 137 (1980): 1232-4
  • 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
  • "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  • 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
  • Gram LF, Overo KF, Kirk L "Influence of neuroleptics and benzodiazepines on metabolism of tricyclic antidepressants in man." Am J Psychiatry 131 (1974): 863-6
  • Mahr GC, Berchou R, Balon R "A grand mal seizure associated with desipramine and haloperidol." Can J Psychiatry 32 (1987): 463-4
  • Goodnick PJ, Jerry J, Parra F "Psychotropic drugs and the ECG: focus on the QTc interval." Expert Opin Pharmacother 3 (2002): 479-98
Haloperidol Decanoate Injection

Generic Name: haloperidol

Brand name: Haldol, Haldol Decanoate

Synonyms: Haloperidol

Tofranil

Generic Name: imipramine

Brand name: Tofranil, Tofranil-PM

Synonyms: n.a.

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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