From the Guidelines
Haloperidol (Haldol) should be avoided in patients with Parkinson's disease due to the risk of exacerbating motor symptoms. According to the ESMO clinical practice guidelines 1, Haldol may cause extrapyramidal side effects (EPSEs) and is not recommended for use in patients with Parkinson's disease or dementia with Lewy bodies. The guidelines suggest alternative medications, such as second-generation antipsychotics like olanzapine, quetiapine, or risperidone, which may have a lower risk of EPSEs.
When considering antipsychotic treatment for patients with Parkinson's disease, it is essential to weigh the potential benefits against the risks of worsening motor symptoms. The mechanism of action of Haldol, which blocks dopamine receptors, directly opposes the goal of Parkinson's treatment, which aims to increase dopamine activity in the brain 1.
Key considerations for managing patients with Parkinson's disease who require antipsychotic treatment include:
- Ruling out medication side effects, infections, or metabolic disturbances as potential causes of psychosis or delirium
- Using the lowest effective dose of antipsychotic medication for the shortest duration possible
- Close monitoring for worsening motor symptoms, such as tremor, rigidity, and bradykinesia
- Considering alternative medications, such as atypical antipsychotics, which may have a lower risk of EPSEs 1.
In summary, the use of Haldol in patients with Parkinson's disease is not recommended due to the risk of exacerbating motor symptoms, and alternative treatments should be considered.
From the FDA Drug Label
Haloperidol tablets are contraindicated in ... individuals who are hypersensitive to this drug or have Parkinson’s disease. EPS during the administration of haloperidol have been reported frequently, often during the first few days of treatment. EPS can be categorized generally as Parkinson-like symptoms, akathisia, or dystonia
The use of Haldol (haloperidol) is contraindicated in patients with Parkinson’s disease. Additionally, Parkinson-like symptoms are a common side effect of haloperidol, particularly during the initial treatment period 2, 2.
From the Research
Haldol and Parkinson's Disease
- There is no direct evidence in the provided studies regarding the use of Haldol in patients with Parkinson's disease.
- However, the studies discuss the use of other antipsychotics, such as quetiapine, clozapine, and pimavanserin, in the treatment of psychosis in Parkinson's disease patients 3, 4, 5, 6.
- Quetiapine is commonly used to treat psychosis in Parkinson's disease patients because it does not worsen motor function and lacks the blood monitoring requirement of clozapine 4.
- Clozapine and pimavanserin have demonstrated efficacy in reducing psychotic symptoms in Parkinson's disease patients, while quetiapine has shown mixed results 5, 6.
- The management of delirium in Parkinson's disease patients involves pharmacological and non-pharmacological measures, including adjustments to anti-parkinsonian medication and the use of neuroleptics in severe cases 7.
- The use of antipsychotics, including Haldol, in Parkinson's disease patients should be approached with caution due to the potential for exacerbating motor symptoms 5, 6.