Haloperidol blood levels and clinical effects.
ABSTRACT This study explored the relationships between plasma levels and the clinical effects of haloperidol in 176 acutely exacerbated schizophrenic or schizoaffective patients. After a single-blind placebo period of 1 week (period 1), they entered the double-blind period 2 randomly assigned to one of three plasma levels of haloperidol: low (2 to 13 ng/mL), medium (13.1 to 24 ng/mL), or high (24.1 to 35 ng/mL). Patients whose conditions did not improve in period 2 continued on one of the three haloperidol levels (period 3). Periods 2 and 3 lasted 6 weeks each. Only minor differences in clinical responses were noted among the three levels of haloperidol. These results imply that low or moderate doses of neuroleptics are appropriate for many acutely psychotic patients.
01/2011; 3(1):008-012. DOI:10.4172/1948-593X.1000037
Article: Newer and Older Antipsychotics[Show abstract] [Hide abstract]
ABSTRACT: The mechanism of action of older antipsychotics, without exception, involves blockade of dopamine D2-receptors. This is the main evidence in support of the dopamine hypothesis of schizophrenia. Because of the shortcomings of older antipsychotics, newer ‘atypical’ antipsychotics have been developed. These agents have novel mechanisms of action. They are active in animal models of psychosis, but do not induce Parkinsonian-like effects in animals. The existence of alternative mechanisms of action of some antipsychotics suggests that the dopamine hypothesis of schizophrenia requires modification. There is little evidence that any one older antipsychotic is superior to any other. With the exception of clozapine, the evidence that any new drug is superior in antipsychotic efficacy to the older drugs is somewhat limited. However, the adverse effect profile of the newer agents is more acceptable. The place of atypical antipsychotics in the overall treatment of schizophrenia is not yet entirely clear. In clinical practice, drug choice is a complex issue. It depends on a combination of patient, drug and illness factors. In particular, adherence to a medication regimen is crucial to therapeutic success. Furthermore, cost has become increasingly relevant to the choice of treatment.CNS Drugs 11/1994; 2(5). DOI:10.2165/00023210-199402050-00006 · 4.38 Impact Factor
Article: Drug-Resistant Schizophrenia[Show abstract] [Hide abstract]
ABSTRACT: The treatment of patients with drug-resistant schizophrenia is a major challenge for both the clinician and the patient, and requires systematic and comprehensive management. Patients should initially be assessed to clarify that they are resistant to therapy, as opposed to noncompliant or undertreated. The dosage of existing antipsychotic should be increased. If no response is observed or intolerable adverse effects occur, an alternative typical antipsychotic should be tried. In the event of nonresponse to this alternative agent, a trial with clozapine (an atypical antipsychotic) can be initiated. In patients failing to respond to any single antipsychotic, there are some alternative somatic treatments often used in combination with antipsychotics. These include lithium, carbamazepine, benzodiazepines, β-adrenergic receptor antagonists, levodopa, reserpine and some antidepressant medications. The reasons for nonresponsiveness are not solely drug related, with psychological and social factors also contributing. Therefore, non-drug strategies, i.e. psychological and social methods, should be used in combination with pharmacological treatments to offer the patient the most consistent benefit. The results of all types of treatment should be evaluated regularly and carefully to allow clear conclusions concerning potential benefits to be made.CNS Drugs 01/1996; 5(1). DOI:10.2165/00023210-199605010-00002 · 4.38 Impact Factor