Haldol and sz threshold

[Jeff698]

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Have any of y'all had any experience with therapeutic doses of haldol lowering the seizure threshold in patients without prior seizure history?

Is this a concern of yours when using haldol for agitated patients in the ED without known seizure history?

Thanks and take care,
Jeff

 

[Seaglass]

It is a known adverse effect. I personally haven't seen it happen but I haven't been around that long.

 

[Sessamoid]

Is this a concern of yours when using haldol for agitated patients in the ED without known seizure history?

Short answer: no.

 

[NinerNiner999]

It is a known side-effect of Haldol but probably wouldn't factor too much into my decision if that was the only drug I had and I needed to use it.

Geodon is a newer atypical antipsychotic with a similar onset of action as Haldol, but without lowering the seizure threshold as much. I like it better for agitated drunks.

 

[Febrifuge]

The docs at my workplace swear by Droperidol. I have never heard or seen reason for concern about seizures.

http://www.mhsource.com/schizophrenia/news13.html

 

[ERMudPhud]

Back when I first looked at this the only real evidence I could find for Haldol lowering sz threshold was experimental evidence in rats. There was no data on increased incidence in blinded studies in people, just a bunch of case reports. I believe the proven benefit of geodon over haldol is in the lowered rate of dystonic reactions and not in a lowered incidence of sz.


As for droperidol the dreaded black box warning has made it unavailable to many of us despite the fact that many if not most neuroleptics prolong the QT like droperidol

Drugs Today (Barc). 2003 Jul;39(7):551-7.
Related Articles, Links


Antipsychotic medication and seizures: a review.

Hedges D, Jeppson K, Whitehead P.

Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, Utah 84602, USA. [email protected]

Both first-generation and second-generation antipsychotic medications can lower the seizure threshold, increasing the chances of seizure induction. This article reviews the published literature concerning the seizure-lowering effects of first- and second-generation antipsychotic medication. Unfortunately, rigorously controlled studies are relatively infrequent, and case reports form a large part of the available literature, limiting the confidence with which firm conclusions can be drawn. Of the first-generation antipsychotic medications, chlorpromazine appears to be associated with the greatest risk of seizure provocation, although other first-generation antipsychotics also lower seizure threshold. Conversely, molindone, haloperidol, fluphenazine, pimozide and trifluoperazine are associated with a lower risk of seizure induction. Clozapine is the second-generation antipsychotic most frequently associated with seizures, with risperidone appearing to confer a relatively low risk. Other factors such as history of seizure activity, concurrent use of other drugs that lower seizure threshold, rapid dose titration, slow drug metabolism, metabolic factors and drug-drug interactions appear to increase the chances of an antipsychotic medication inducing seizure activity.

 

[Sessamoid]

Back when I first looked at this the only real evidence I could find for Haldol lowering sz threshold was experimental evidence in rats. There was no data on increased incidence in blinded studies in people, just a bunch of case reports. I believe the proven benefit of geodon over haldol is in the lowered rate of dystonic reactions and not in a lowered incidence of sz.

I shouldn't give Haldol to rats? That's going to limit my use of Haldol significantly, considering my patient population!
🙂