Allergy to Haldol? Give Zyprexa instead?

[bisell26]

Hi,
I was wondering, on the inpatient unit, or even just in general, say if a patient is allergic to Haldol, say they get a rash, is it okay to use any of the other typical ones like Chlorpromazine?

if they have had a dystonic reaction in the past, is it okay to do a SGA like Zyprexa with Cogentin?

I'm still trying to wrap my head around all these contraindications and indications as they were a lot easier in med school and I don't want to kill anyone with acute dystonia or NMS as an intern lol

Thanks

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[PistolPete]

Yes. Just because they might have an allergy to haldol doesn't mean they'll have an allergy to Zyprexa. Yes, there is less likelihood of dystonia on an atypical antipsychotic, but it can still happen, even tardive dyskinesia.

Apparently cogentin loses its efficacy to prevent EPS after a few months, although I don't have a reference for you.

 

[splik]

only since the new drugs have the resorted to the intelluctual dumbing down of lumping all the first generation drugs together. haloperidol is a butyrophenone. chlorpromazine is a phenothiazine. EPSE is much more common with haldol than it is with chlorpromazine. as for the rash well you can give it a try. thorazine tends to cause more skin problems (usually hypersensitivity to light so you get a nice tan or the classic slate grey discoloration).

If someone had a dystonic reaction w/ an oral formulation (as opposed to IM where risk is much higher) most people would consider seroquel or one of the weaker dopamine antagonists.

you're not a real doctor until you kill someone!

 

[wolfvgang22]

If somebody has an allergy to haldol but I really wanted to use haldol, I use prolixin instead.

 

[deleted314290]

They are just lying to you, give them the haldol anyway...

 

[Dharma]

Prolixin on deck.

 

[bisell26]

Thanks for the responses...glad to know i'm on the right chain of thinking.

 

[Merovinge]

Hi,
I was wondering, on the inpatient unit, or even just in general, say if a patient is allergic to Haldol, say they get a rash, is it okay to use any of the other typical ones like Chlorpromazine?

if they have had a dystonic reaction in the past, is it okay to do a SGA like Zyprexa with Cogentin?

I'm still trying to wrap my head around all these contraindications and indications as they were a lot easier in med school and I don't want to kill anyone with acute dystonia or NMS as an intern lol

Thanks

If they've had NMS in the past, well definitely discuss with your attending before restarting any dopamine blocking agent! Otherwise great to ask these questions, I think SDN folks that respond frequently were as good or better than some of my attendings and if you have the curiosity you will find (at least serviceable) answer.