What are the screening tools for Haloperidol (antipsychotic medication)?

From the Guidelines

Haloperidol screening should include a baseline electrocardiogram (ECG) to assess QTc interval, complete blood count, comprehensive metabolic panel including liver function tests, and assessment of neurological status, as recommended by the most recent and highest quality study 1. Before initiating haloperidol, clinicians should obtain a thorough medication history to identify potential drug interactions and screen for conditions that may increase risk of adverse effects, such as history of cardiac arrhythmias, seizure disorders, Parkinson's disease, or dementia with Lewy bodies. Regular monitoring should include ECG for QTc prolongation (especially at doses above 2mg daily), extrapyramidal symptoms assessment using scales like the Abnormal Involuntary Movement Scale (AIMS) or Simpson-Angus Scale, and metabolic parameters including glucose and lipids. Baseline prolactin levels may be useful if sexual dysfunction or gynecomastia is a concern. These screening tools are essential because haloperidol, a first-generation antipsychotic, carries risks of QTc prolongation that can lead to potentially fatal arrhythmias, extrapyramidal symptoms including tardive dyskinesia, neuroleptic malignant syndrome, and metabolic disturbances. Elderly patients require more careful screening and typically lower doses due to increased sensitivity to adverse effects. Some key points to consider when screening for haloperidol include:

• Assessing the patient's cardiac risk factors, such as history of cardiac arrhythmias or QTc prolongation 1
• Monitoring for extrapyramidal symptoms, such as akathisia, dystonia, or parkinsonism 1
• Evaluating the patient's metabolic parameters, including glucose and lipids 1
• Considering the patient's medication history and potential drug interactions 1
• Assessing the patient's neurological status, including cognitive function and mood 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Screening Tools for Haloperidol

• The Simpson-Angus Scale (SAS) is a widely used screening tool for extrapyramidal symptoms (EPS) induced by haloperidol 2, 3, 4, 5, 6.
• The SAS contains 10 items, including gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, glabella tap, tremor, and salivation, each rated between 0 and 4 3.
• A total score is obtained by adding the items and dividing by 10, with scores of up to 0.3 considered within the normal range 3.
• The Abnormal Involuntary Movement Scale (AIMS) is also used to assess tardive dyskinesia, a type of EPS 4, 5, 6.
• The Barnes Akathisia Scale is used to assess akathisia, another type of EPS 2.
• The Positive and Negative Syndrome Scale (PANSS) is used to assess the severity of psychotic symptoms, including negative symptoms 2, 4, 5, 6.

Risk Factors for Extrapyramidal Side Effects

• Negative symptoms, as measured by the PANSS, are associated with an increased risk of EPS 5.
• First-generation antipsychotic prescription, such as haloperidol, is associated with an increased risk of EPS 5.
• Anticholinergic drug administration is also associated with an increased risk of EPS 5.
• Disorganization, as measured by the PANSS, is associated with an increased risk of tardive dyskinesia 5.

Comparison of Haloperidol with Other Antipsychotics

• Olanzapine has been shown to be effective in reducing EPS in patients with haloperidol-induced EPS 2.
• Risperidone has been shown to have better extrapyramidal tolerability and treatment retention rate than haloperidol in patients with first-episode schizophrenia 6.
• Olanzapine has been shown to be more effective than haloperidol in improving negative symptoms and overall symptomatic improvement in patients with schizophrenia 4.