Haldol - why is it legal?

[phoenixsupra]

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I had the wonderful experience of arriving at work today to find, one of my patients, a 22 year old kid, showing the first signs of tardive dyskinesia. The cause? The haldol that I ordered for him on Friday. I was against it and wanted to give him some risperdal instead but apparantly cost is the prime issue and my better judgement was vetoed. I'm not going into psych and I'm not convinced that anything we're doing in phych hospitals is humane or reasonable, anyway. This kid was having a "psychotic break". If you ask me it was nothing that couldn't be dealt with by having someone listen to him for a while to find out how he got that way. Anyway, that's a whole nother issue. I'm more than a bit pissed that this kid is probably a lot worse off now than if he never found his way to medical care. This really isn't what I'm in medicine for.

Sure, psych patients are disenfranchised and don't tend to be top of most peoples worry list. But how many of you have ever had surgery. Post-op or ICU psychosis is far from being an unusual phenomenon. And we squirt that stuff into people - regular sane respectable people - in that situation, on a regular basis with very little consideration. As far as I can tell the 'rare' TD ain't so rare at all. In this place it's more of a 'sooner or later' phenomenon and it can kick in after just one dose.

So here's my question. Can someone explain to me what the political forces are that keep a drug like this on the market? Surely if we placed an outright ban on typicals the price of atypicals would fall. Am I just being naive? Really, what's the bigger picture on this? I for one am never gonna write an order for that crap again no matter who's twisting my arm.

 

[bananaface]

We haven't found a perfect psych med yet. It's all a question of balancing risks.

I have never heard of tardive dyskinesia happening after a single dose of a psych med. Since TD is supposedly a result of shrinkage of the substantia niagara over time, one would think this could not have been his first experience with psych meds. Am I off base here? Other opinions?

 

[ForgetMeNot]

Surely if we placed an outright ban on typicals the price of atypicals would fall. Am I just being naive?

Yes.

 

[ultracet]

because unfortunately the people in charge know only about numbers and "being in the black"
haldol is cheap and it works.
that's pretty much the extent of it.

and unfortunately if you work in a hospital..... write what you want... it will be changed to formulary and then given to the patient.
that is unless you are in a rural area and they are dying for you to be there with them

 

[Anasazi23]

I had the wonderful experience of arriving at work today to find, one of my patients, a 22 year old kid, showing the first signs of tardive dyskinesia. The cause? The haldol that I ordered for him on Friday. I was against it and wanted to give him some risperdal instead but apparantly cost is the prime issue and my better judgement was vetoed.

If he's 22, probably having his first psychotic break, and is neuroleptically naive, it is wrong to use a typical in most cases. What dose did you use? Via what route? Why not with cogentin?

BTW, it's probably not TD, but dystonic reaction to the haldol.

I'm not going into psych and I'm not convinced that anything we're doing in phych hospitals is humane or reasonable, anyway. This kid was having a "psychotic break". If you ask me it was nothing that couldn't be dealt with by having someone listen to him for a while to find out how he got that way. Anyway, that's a whole nother issue.

This is a very naive view of modern psychiatry and frankly, shows a lack of understanding of the biological underpinnings of psychopathology. You can't "talk someone out" of a psychotic break.

I'm more than a bit pissed that this kid is probably a lot worse off now than if he never found his way to medical care. This really isn't what I'm in medicine for.

Sure, psych patients are disenfranchised and don't tend to be top of most peoples worry list. But how many of you have ever had surgery. Post-op or ICU psychosis is far from being an unusual phenomenon. And we squirt that stuff into people - regular sane respectable people - in that situation, on a regular basis with very little consideration. As far as I can tell the 'rare' TD ain't so rare at all. In this place it's more of a 'sooner or later' phenomenon and it can kick in after just one dose.

ICU psychosis, aka, delirium, carries a 50% mortality rate according to some studies....you've got to "squirt that stuff" into them or you could let them die.

So here's my question. Can someone explain to me what the political forces are that keep a drug like this on the market? Surely if we placed an outright ban on typicals the price of atypicals would fall. Am I just being naive? Really, what's the bigger picture on this? I for one am never gonna write an order for that crap again no matter who's twisting my arm.

Haldol is one of the best psychotropic medications available for psychosis, and when used properly, is extremely effective. You have to know how to dose it, whom to give it to, and how to monitor for adverse effects and deal with them appropriately.

Next time use a lower dose in someone neuroleptically naive and give it with cogentin...after they fail an atypical.

 

[phoenixsupra]

Yes.

Rhetorical question, ****** 🙄 Educate me. 😉

 

[phoenixsupra]

We haven't found a perfect psych med yet. It's all a question of balancing risks.

Well typicals are just about the "least perfect" there is. Seriously, the "side effects" around here look at lot worse than the origional problem, from what I can see.

I have never heard of tardive dyskinesia happening after a single dose of a psych med. Since TD is supposedly a result of shrinkage of the substantia niagara over time, one would think this could not have been his first experience with psych meds. Am I off base here? Other opinions?

Nah, we had a steep learning curve on that today. It's possible 🙁

 

[phoenixsupra]

If he's 22, probably having his first psychotic break, and is neuroleptically naive, it is wrong to use a typical in most cases. What dose did you use? Via what route? Why not with cogentin?

That's exactly what I said. 😉 He's loaded with cogentin now. Quick let's close the stable door now that the horse has run off 🙄

BTW, it's probably not TD, but dystonic reaction to the haldol.

Well, we're hoping it's just EPS. Sure looks like TD though 👎

This is a very naive view of modern psychiatry and frankly, shows a lack of understanding of the biological underpinnings of psychopathology. You can't "talk someone out" of a psychotic break.

Doesn't sound like you've actually seen "modern" psychiatry. Go to a pig farm. Look around. Very similar. And, yes you can talk someone out of the "positive symptoms" of a "psychotic break". Don't get so damn lost in jargon. I've done it. 😉 Wasn't an option here. Long story.

ICU psychosis, aka, delirium, carries a 50% mortality rate according to some studies....you've got to "squirt that stuff" into them or you could let them die.

Or you could squirt in something else 😉

Haldol is one of the best psychotropic medications available for psychosis, and when used properly, is extremely effective. You have to know how to dose it, whom to give it to, and how to monitor for adverse effects and deal with them appropriately.

Total bs. All it is is a major tranquilizer. You sound like my freeko attending. He's a big ect buff too.

Next time use a lower dose in someone neuroleptically naive and give it with cogentin...after they fail an atypical.

Duh 🙄Actually almost no one "fails" atypicals. As far as I can gather from asking around, that's basically a loophole to keep it on the market. I'm sure someone's palm was nicely greased to facilitate that. Seriously, if we make stuff like this and it's cheap then the bean counters will go for it every time. The fact that we still make this crap is inexcusable.

 

[Anasazi23]

Doesn't sound like you've actually seen "modern" psychiatry. Go to a pig farm. Look around. Very similar. And, yes you can talk someone out of the "positive symptoms" of a "psychotic break". Don't get so damn lost in jargon. I've done it. 😉 Wasn't an option here. Long story.

I see it everyday. I'm a psychiatry resident. I'm telling you, you can NOT talk someone out of a florid psychotic break. I've seen many psychiatrists try it dozens of times....usually with poor results.

Or you could squirt in something else 😉

Like what? Look up the efficacy studies. You'll be impressed with haldol. It's part of the guidelines.

Total bs. All it is is a major tranquilizer. You sound like my freeko attending. He's a big ect buff too.

Absolutely untrue. You really need to bone up on your psychopharm. Explaining the mechanisms of action of D2 blockade and psychotic symptoms would take much more time than I have.

Don't get on the dissing ect bandwagon either. Look up the efficacy studies.

Duh 🙄Actually almost no one "fails" atypicals.

Again, absolutely untrue. I see it all the time. Patients - controlled only on typicals.

As far as I can gather from asking around, that's basically a loophole to keep it on the market. I'm sure someone's palm was nicely greased to facilitate that. Seriously, if we make stuff like this and it's cheap then the bean counters will go for it every time. The fact that we still make this crap is inexcusable.

The truth is that haldol is a very safe drug if you know how to use it. It's done a lot of good for a lot of people. Atypicals are great too, for certain situations. Atypicals aren't as benign as you think, either. Lots of serious life-long side effects occur from those too.

 

[skp]

oooo...
i like this thread

one question
what is a "psychotic break"?

thanks!
-the humble skp

 

[dgroulx]

When we were taught antipsychotics in last year's therapeutics course, they gave us the Texas Medicaid Treatment Guidelines to follow. I'm in Florida, but they gave us the Texas ones anyway. 😕

These guidelines state that if a patient has no history of treatment failure and this is his first episode, then try one of these 3 atypicals: olanzipine, quetiapine or risperdal. If treatment fails, then choose another atypical. If the 2nd one fails, you can either try the 3rd or move to Haldol at that point.

There are about 4 theories for psychotic disorders, but it is most likely a combination of all theories. There is an increase in D2 receptors in the mesolimbic area of the brain (pos symptoms) and too few D2 receptors in the mesocortical area (neg symptoms). They've also found a loss of glutamate transmission (NMDA receptors) in the hippocampus, amygdala & prefrontal cortex. The increase in dopamine is actually thought to be because there are too many presynaptic 5HT2 receptors in the prefrontal cortex, which will decrease dopamine release. Brain chemistry is very complex and we are learning things every day. The serotonin hypothesis is the one that they stressed in our pharmacology class.

Haldol blocks these receptors from highest to lowest affinity: D3, D2, D4, alpha 1, then has a teeny bit of affinity for 5HT. Where Risperdal blocks 5HT2A, alpha 1, D2, D3 & D4 (equally), 5HT2C, then finally D1.

 

[BMBiology]

High potency typicals such as haldol, prolixin may cause EPSEs including tardive dyskineisa (may be irreversible!). This is not rare: 5% on haldol experience tardive dyskinesia the first year; 20% within 4 years. However, the low potency typicals (e.g. mellaril) rarely cause EPSEs. If your main concern is tardive dyskinesia then I would suggest that you do not use resperdal as well. The risk of EPSEs as a result of using resperdal is moderately high when the dose is over 6 mg/day. If the patient is experiencing tardive dyskinesia, I would not start the patient on anticholingergics such as cogentin because it can worsten his tardive dyskinesia!

As pharmacy students, we are not trained to make diagnosis. The symptoms of acute dystonic reactions are associated with painful muscle spasms of the eyes, face, back, throat while tardive dyskinesia symptoms are not associated with pain. In this case, I don't think your patient is suffering from tardive dyskinesia because the onset is mths to years. Most likely, your patient is experiencing acute dystonic reactions. Most patients that suffer from EPSEs usually experience acute dystonic reactions first because the onset is hours to the first 5 days (< 3 mths). This is reversible. You can manage acute dystonic reactions with either anticholinergic, benzodiazepines (if this is your choice, make sure the patient is not drinking alcohol!), or change to an atypical.

It is pretty much "inhumane" to start someone on typical nowadays because of the major side effects and typicals do not treat the negative symptoms. However, some people are still on typical medications because they have been taking it for a while and it has been effective for them or the atypical medications are not effective. In your case, I would suggest that you start the patient on an atypical. If cost is your major concern then I would suggest zyprexa because it now comes in generic. The recommended starting dose is 5-20 mg/day. However, if your patient smokes (a lot of psychotic patients do btw), then you need to start at a higher dose (25-30mg/day) because smoking metabolizes zyprexa at a faster rate. The risk for EPSE is rather low with zyprexa. However, the risk of sedation, weight gain, and sexual side-effects are high as compared to the other atypical medications. Make sure your patient know the potential side effects.

Abilify and Geodon are the newer typicals. Side effects such as sedation, weight gain, and sexual side effects are considered to be less but since they are new, not all side effects are known yet. However, Geodon has been shown to cause increase in QTc prolongation. So if your patient has been using Mellaril, which may also cause QTc prolongation, then Geodon is not recommended. I hope this helps.

 

[bananaface]

(slightly off topic)

Mellaril (thioridazine) has a black box warning stating that it is to be used only as a third line therapy for patients in institutionalized settings, who can be closely monitored. I had an ex-in law who was on it (and showing signs of both EPS and overdose) until I raised the issue with her physician. Every single other med she was on but one was in all likelihood treating an effect caused by the Mellaril. One symptom she experienced was a pseudo-parkinson syndrome, which is not the same as TD in terms of symptomology and likelihood of reversibility. Anyway, I guess my point is that you can't just jump on the TD bandwagon because a dyskinesia is present. And, Mellaril is a hella crappy drug. 😉

(back on topic)
But, you know we keep these crappy drugs around for refractory cases. No one ever claimed that drugs were safe. They are prescription because either the manufacturer wants to cash in on a branded product, or because they are not able to be used safely by the public without supervision by those in the medical field.

 

[phoenixsupra]

These guidelines state that if a patient has no history of treatment failure and this is his first episode, then try one of these 3 atypicals: olanzipine, quetiapine or risperdal. If treatment fails, then choose another atypical. If the 2nd one fails, you can either try the 3rd or move to Haldol at that point.

.

This is what I learned in school too. 👍

 

[phoenixsupra]

High potency typicals such as haldol, prolixin may cause EPSEs including tardive dyskineisa (may be irreversible!). This is not rare: 5% on haldol experience tardive dyskinesia the first year; 20% within 4 years. However, the low potency typicals (e.g. mellaril) rarely cause EPSEs. If your main concern is tardive dyskinesia then I would suggest that you do not use respirdal as well. The risk of EPSEs as a result of using resperdal is moderately high when the dose is over 6 mg/day. If the patient is experiencing tardive dyskinesia, I would not start the patient on anticholingergics such as cogentin because it can worsten his tardive dyskinesia!

As pharmacy students, we are not trained to make diagnosis. The symptoms of acute dystonic reactions are associated with painful muscle spasms of the eyes, face, back, throat while tardive dyskinesia symptoms are not associated with pain. In this case, I don't think your patient is suffering from tardive dyskinesia because the onset is mths to years. Most likely, your patient is experiencing acute dystonic reactions. Most patients that suffer from EPSEs usually experience acute dystonic reactions first because the onset is hours to the first 5 days (< 3 mths). This is reversible. You can manage acute dystonic reactions with either anticholinergic, benzodiazepines (if this is your choice, make sure the patient is not drinking alcohol!), or change to an atypical.

It is pretty much "inhumane" to start someone on typical nowadays because of the major side effects and typicals do not treat the negative symptoms. However, some people are still on typical medications because they have been taking it for a while and it has been effective for them or the atypical medications are not effective. In your case, I would suggest that you start the patient on an atypical. If cost is your major concern then I would suggest zyprexa because it now comes in generic. The recommended starting dose is 5-20 mg/day. However, if your patient smokes (a lot of psychotic patients do btw), then you need to start at a higher dose (25-30mg/day) because smoking metabolizes zyprexa at a faster rate. The risk for EPSE is rather low with zyprexa. However, the risk of sedation, weight gain, and sexual side-effects are high as compared to the other atypical medications. Make sure your patient know the potential side effects.

Abilify and Geodon are the newer typicals. Side effects such as sedation, weight gain, and sexual side effects are considered to be less but since they are new, not all side effects are known yet. However, Geodon has been shown to cause increase in QTc prolongation. So if your patient has been using Mellaril, which may also cause QTc prolongation, then Geodon is not recommended. I hope this helps.

BMbiology, That helps a lot. I appreciate the information. 😎 What you're telling me is somewhat reassuring. The word from the trenches about Abilify is that it doesn't really work, btw. Thanks much 🙂

 

[phoenixsupra]

I see it everyday. I'm a psychiatry resident. I'm telling you, you can NOT talk someone out of a florid psychotic break. I've seen many psychiatrists try it dozens of times....usually with poor results.

Problem with psychiatry residents is that in general you're a bunch of whacked out loony freaks with no real clue about people.

Like what? Look up the efficacy studies. You'll be impressed with haldol. It's part of the guidelines.

*translation* Yeah, I'm right. It's in da books. Go look.

You really need to bone up on your psychopharm. Explaining the mechanisms of action of D2 blockade and psychotic symptoms would take much more time than I have.

That's precisely why I posted this in pharm and not in psych. The only thing that outweighs the sheer ignorance of psych residents is their lazyness. I regularly am asked to write notes on patients who I havn't even seen, so my resident can duck out earlier "Oh, it doesn't matter, just write the same thing as yesterday". When you rotate through other services you guys are notorious for just making **** up and vanishing without leave. And anyway, you guys put in less time than anyone else in medicine. Step back, loser, and let those who actually know something about the subject answer the question 🙄

The truth is that haldol is a very safe drug if you know how to use it. It's done a lot of good for a lot of people. Atypicals are great too, for certain situations. Atypicals aren't as benign as you think, either. Lots of serious life-long side effects occur from those too.

Blatently contradicted by the posts of others here who actually know something and aren't too lazy to share it. Of course there are SE's to atypicals. Just much less than typicals. That's why typicals should only be used as something of a last resort. Do please, share the special esoteric "way to use" haldol, you have learned, that reduces the universally known risks of devastating side effects. Does it involve crystals and chanting

 

[phoenixsupra]

But, you know we keep these crappy drugs around for refractory cases. No one ever claimed that drugs were safe. They are prescription because either the manufacturer wants to cash in on a branded product, or because they are not able to be used safely by the public without supervision by those in the medical field.

I agree, banana. In this case cost was the ONLY rational for the selection. The kid was still showing the same Sx's today. We shipped him out to another state (previously planned) with cogentin as his "only" med. I didn't see any mention of the depo haldol we shot him with, anywhere in the paperwork. Perhaps I missed it. I hope this boy just had EPSE's that will fade in time. I doubt if I'll ever know for sure.

 

[BMBiology]

Patient must first be stabilized on and show good responses to oral haldol before the depot haldol is used.

Depot dosing: 10-15 times the stabilized daily oral (po) dose given monthly; not to exceed 100mg IM for the first test dose! PO overlaping may be required for the first several weeks.

 

[Caverject]

When we were taught antipsychotics in last year's therapeutics course, they gave us the Texas Medicaid Treatment Guidelines to follow. I'm in Florida, but they gave us the Texas ones anyway. 😕

These guidelines state that if a patient has no history of treatment failure and this is his first episode, then try one of these 3 atypicals: olanzipine, quetiapine or risperdal. If treatment fails, then choose another atypical. If the 2nd one fails, you can either try the 3rd or move to Haldol at that point.

There are about 4 theories for psychotic disorders, but it is most likely a combination of all theories. There is an increase in D2 receptors in the mesolimbic area of the brain (pos symptoms) and too few D2 receptors in the mesocortical area (neg symptoms). They've also found a loss of glutamate transmission (NMDA receptors) in the hippocampus, amygdala & prefrontal cortex. The increase in dopamine is actually thought to be because there are too many presynaptic 5HT2 receptors in the prefrontal cortex, which will decrease dopamine release. Brain chemistry is very complex and we are learning things every day. The serotonin hypothesis is the one that they stressed in our pharmacology class.

Haldol blocks these receptors from highest to lowest affinity: D3, D2, D4, alpha 1, then has a teeny bit of affinity for 5HT. Where Risperdal blocks 5HT2A, alpha 1, D2, D3 & D4 (equally), 5HT2C, then finally D1.

The Texas study is an innovator study, and I believe the only one like it.

 

[bananaface]

I agree, banana. In this case cost was the ONLY rational for the selection. The kid was still showing the same Sx's today. We shipped him out to another state (previously planned) with cogentin as his "only" med. I didn't see any mention of the depo haldol we shot him with, anywhere in the paperwork. Perhaps I missed it. I hope this boy just had EPSE's that will fade in time. I doubt if I'll ever know for sure.

Oh geez. It cheezes me off that he was probably sent packing with an incomplete medical record.

 

[phoenixsupra]

I have been officially warned by her most imperial highness, the illustrious and sexy bananaface, that calling another poster, even though they be a psych resident, a ******, is not acceptable behavior in the pharmacy forum. I hereby retract that statement.

Psyh residents are very competent and are not at all lazy. That is all. 😎

Thank you all for your kind and expert help with this issue. 🙂

 

[ZpackSux]

Why is Haldol legal?

Because it works. And because not all patients experience EPS and other ADRs. Still, hard to believe Risperdal is not on the formulary.

Benefit vs Risk. Which is more important.

Case study:

Patient with history of GI rectal bleed comes in with ACS.... Do you anticoagulate - Heparinize the patient to prevent more clots.. or do you not anticoagulate the patient because he has a hx of bleed...

 

[bananaface]

I have been officially warned by her most imperial highness, the illustrious and sexy bananaface, that calling another poster, even though they be a psych resident, a ******, is not acceptable behavior in the pharmacy forum. I hereby retract that statement.

Psyh residents are very competent and are not at all lazy. That is all. 😎

Thank you all for your kind and expert help with this issue. 🙂

While you're at it, let's talk about how it's not cool to take money out of my wallet. 😛

*waits for you to hand over millions and millions of dollars in unmarked small bills*

 

[Caverject]

I have been officially warned by her most imperial highness, the illustrious and sexy bananaface, that calling another poster, even though they be a psych resident, a ******, is not acceptable behavior in the pharmacy forum. I hereby retract that statement.

So lying is acceptable?


*that's for editing my post yesterday

 

[bananaface]

So lying is acceptable?


*that's for editing my post yesterday

Apparently it is, as you showed us yesterday, Mr. "I know how to use italics and throw a temper tantrum".

 

[ZpackSux]

Psyh residents are very competent and are not at all lazy. That is all.

I don't know... I only spent 6 weeks in psych rotation.. But there was a fine line separating the sanity between the psych patients and the employees of the psych hospital.. very fine line.

 

[Caverject]

I don't know... I only spent 6 weeks in psych rotation.. But there was a fine line separating the sanity between the psych patients and the employees of the psych hospital.. very fine line.

Hey Zpak,

Did you see these two while you were there?

 

[ZpackSux]

Hey Zpak,

Did you see these two while you were there?

Yup...they were there. One is a patient and the other is a staff.

 

[Caverject]

lol...I saw them both in a movie one time....

 

[ZpackSux]

lol...I saw them both in a movie one time....

Yes..I've worked with famous people...

 

[bananaface]

lol...I saw them both in a movie one time....

Were there lots of people in nurses uniforms and white coats in this movie theater?

 

[Anasazi23]

Problem with psychiatry residents is that in general you're a bunch of whacked out loony freaks with no real clue about people.

That's precisely why I posted this in pharm and not in psych. The only thing that outweighs the sheer ignorance of psych residents is their lazyness. .... And anyway, you guys put in less time than anyone else in medicine. Step back, loser, and let those who actually know something about the subject answer the question .....
[about haldol]
Blatently contradicted by the posts of others here who actually know something and aren't too lazy to share it. Of course there are SE's to atypicals. Just much less than typicals. That's why typicals should only be used as something of a last resort. Do please, share the special esoteric "way to use" haldol, you have learned, that reduces the universally known risks of devastating side effects. Does it involve crystals and chanting

I was actually going to respond to all this, when I realized that the sheer lack of substance, baseless insults, and demonstrated clear ignorance about an entire field of medicine is too large a task to undertake in this forum. This will no doubt brand me as "lazy" again. The truth is that I'll be late for work, and have lots of patients to see.

You have a lot to learn. Good luck.

 

[DocWagner]

I have used Haldol acutely more times than I can count with no adverse events. I have found it TREMENDOUSLY beneficial for acute psychotic episodes, TBI patients, acutely combative chronic dementia patients, and patients requiring sedation for combative behavior that also have coexisting hypotension.
It is a FANTASTIC med for the Emergency Department...

But then again, I think I have simply walked into a name-calling post and not a discussion regarding clinical usage of the drug.

 

[ultracet]

I have used Haldol acutely more times than I can count with no adverse events. I have found it TREMENDOUSLY beneficial for acute psychotic episodes, TBI patients, acutely combative chronic dementia patients, and patients requiring sedation for combative behavior that also have coexisting hypotension.
It is a FANTASTIC med for the Emergency Department...

But then again, I think I have simply walked into a name-calling post and not a discussion regarding clinical usage of the drug.

I have heard ER docs that swear by it

 

[MRBPharmD]

Problem with psychiatry residents is that in general you're a bunch of whacked out loony freaks with no real clue about people.





*translation* Yeah, I'm right. It's in da books. Go look.




That's precisely why I posted this in pharm and not in psych. The only thing that outweighs the sheer ignorance of psych residents is their lazyness. I regularly am asked to write notes on patients who I havn't even seen, so my resident can duck out earlier "Oh, it doesn't matter, just write the same thing as yesterday". When you rotate through other services you guys are notorious for just making **** up and vanishing without leave. And anyway, you guys put in less time than anyone else in medicine. Step back, loser, and let those who actually know something about the subject answer the question 🙄




Blatently contradicted by the posts of others here who actually know something and aren't too lazy to share it. Of course there are SE's to atypicals. Just much less than typicals. That's why typicals should only be used as something of a last resort. Do please, share the special esoteric "way to use" haldol, you have learned, that reduces the universally known risks of devastating side effects. Does it involve crystals and chanting

Are you a practicing pharmacist? I hope not. With the exception of your belief that atypicals should be first line, many of your attacks on Haldol are way off base. The MDs have responded in an intelligent manner. You should learn from them. You really ARE naive.

 

[Glycerin]

Are you a practicing pharmacist?

He is not a pharmacist.