haloperidoli

Haloperidolo (haloperidol) is a typical antipsychotic of the butyrophenone class. It is used to treat schizophrenia and other psychoses, to manage acute agitation or delirium in emergency settings, and to reduce tics in Tourette syndrome. It is available as oral tablets or solution, as an intramuscular injection for rapid control of agitation, and as a long-acting injectable depot formulation (haloperidol decanoate).

Mechanism of action: Haloperidolo acts primarily as a dopamine D2 receptor antagonist in the central nervous system. By blocking D2 receptors in mesolimbic pathways, it helps reduce positive symptoms of psychosis. Blockade in the nigrostriatal pathway can cause extrapyramidal symptoms. Compared with some other antipsychotics, haloperidolo has relatively limited anticholinergic effects, but it can still cause sedation and orthostatic hypotension due to alpha-adrenergic blockade.

Common adverse effects and cautions: Extrapyramidal symptoms (acute dystonia, parkinsonism, akathisia) are common, and tardive dyskinesia can occur with long-term use. Additional effects include sedation, dizziness, hypotension, and, at higher doses, QT interval prolongation. Neuroleptic malignant syndrome is rare but serious. Haloperidolo is associated with increased mortality in elderly patients with dementia-related psychosis and is generally avoided in that population. It should be used with caution during pregnancy and is excreted in breast milk.

Interactions and monitoring: Coadministration with other central depressants can enhance sedation. It interacts with drugs affecting hepatic enzymes (notably CYP3A4 and 2D6). Patients should be monitored for EPS, metabolic changes, and cardiovascular effects, with dose adjustments as needed. In planning long-term therapy, the risk of tardive dyskinesia should be weighed against benefits.