Does Haldol (Haloperidol) cause muscle weakness in older adults?

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Haldol i mišićna slabost kod starijih osoba

Da, Haldol (haloperidol) može dovesti do mišićne slabosti kod starijih osoba, prvenstveno kroz ekstrapiramidalne nuspojave koje uključuju parkinsonizam, distoniju i akatiziju. 1, 2

Mehanizam djelovanja i rizici

Haloperidol je tipični antipsihotik koji može uzrokovati nekoliko vrsta motoričkih poremećaja koji dovode do mišićne slabosti:

  • Parkinsonizam: Uključuje rigidnost mišića, tremor i bradikineziju (usporene pokrete) što može izgledati kao slabost
  • Akutna distonija: Nevoljni mišićni grčevi koji mogu zahvatiti lice, vrat i ekstremitete
  • Akatizija: Motorički nemir koji može maskirati ili pogoršati mišićnu slabost
  • Tardivna diskinezija: Dugoročna komplikacija koja uključuje nevoljne pokrete 3, 2

Faktori rizika kod starijih osoba

Starije osobe su posebno osjetljive na nuspojave haloperidola zbog:

  • Smanjenog metabolizma lijekova
  • Veće osjetljivosti dopaminergičkog sustava na blokadu
  • Češće polifarmacije koja može pojačati nuspojave
  • Postojećih komorbiditeta koji mogu pogoršati simptome 1

Dokazi o rizicima

Istraživanja pokazuju da:

  • Incidencija parkinsonizma je veća pri višim dozama haloperidola i kod mlađih pacijenata, ali stariji pacijenti imaju veći rizik od tardivne diskinezije 4
  • Čak i pri niskim dozama (prosječno 1,68 mg/dan), 12-mjesečna incidencija tardivne diskinezije bila je 12,3%, s većim rizikom kod starijih pacijenata 5
  • Studija iz 2023. godine pokazala je da niske doze haloperidola (≤0,5 mg) mogu biti jednako učinkovite kao i više doze kod starijih pacijenata, uz manje nuspojava 6

Preporuke za praksu

  1. Izbjegavati dugoročnu upotrebu haloperidola kod starijih osoba kad god je moguće 1

  2. Ako je neophodna primjena:

    • Koristiti najnižu učinkovitu dozu (0,5 mg ili manje) 6
    • Redovito pratiti pojavu ekstrapiramidalnih simptoma
    • Razmotriti alternativne atipične antipsihotike s manjim rizikom od ekstrapiramidalnih simptoma (npr. kvetiapin, olanzapin) 1, 3

  3. Kod pojave mišićne slabosti ili drugih ekstrapiramidalnih simptoma:

    • Razmotriti smanjenje doze ili prekid terapije
    • Antikolinergički lijekovi (npr. biperiden) mogu pomoći kod parkinsonizma
    • Benzodiazepini (npr. lorazepam) mogu biti učinkoviti za akatiziju 3, 4

Oprez i praćenje

  • Redovito pratiti znakove ekstrapiramidalnih nuspojava
  • Biti svjestan da haloperidol može uzrokovati i druge ozbiljne nuspojave, uključujući neuroleptički maligni sindrom i produljenje QT intervala 1, 2
  • Razmotriti alternativne atipične antipsihotike koji imaju manji rizik od ekstrapiramidalnih simptoma - risperidon je pokazao značajno manji rizik od tardivne diskinezije u usporedbi s haloperidolom kod starijih pacijenata 7

Važno je napomenuti da FDA upozorava na povećan rizik od smrti kod starijih osoba s demencijom koji se liječe antipsihoticima, uključujući haloperidol, te bi se trebali koristiti samo kada je korist veća od rizika 1, 2.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Management of Chronic Extrapyramidal Symptoms

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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