Haloperidol

When used simultaneously with drugs that have a depressant effect on the central nervous system, ethanol may increase central nervous system depression, respiratory depression and hypotensive effects.

With the simultaneous use of drugs that cause extrapyramidal reactions, the frequency and severity of extrapyramidal effects may increase.

With the simultaneous use of drugs with anticholinergic activity, the anticholinergic effects may be enhanced.

When used simultaneously with anticonvulsants, it is possible to change the type and/or frequency of epileptiform seizures, as well as reduce the concentration of haloperidol in the blood plasma; with tricyclic antidepressants (including desipramine) - the metabolism of tricyclic antidepressants decreases and the risk of developing seizures increases.

With simultaneous use, haloperidol potentiates the effect of antihypertensive drugs.

When used simultaneously with beta-blockers (including propranolol), severe arterial hypotension is possible. With the simultaneous use of haloperidol and propranolol, a case of severe arterial hypotension and cardiac arrest has been described.

With simultaneous use, a decrease in the effect of indirect anticoagulants is observed.

When used simultaneously with lithium salts, the development of more pronounced extrapyramidal symptoms is possible due to increased blockade of dopamine receptors, and when used in high doses, irreversible intoxication and severe encephalopathy are possible.

When used simultaneously with venlafaxine, it is possible to increase the concentration of haloperidol in the blood plasma; with guanethidine - the hypotensive effect of guanethidine may be reduced; with isoniazid - there are reports of increased concentrations of isoniazid in the blood plasma; with imipenem - there are reports of transient arterial hypertension.

When used simultaneously with indomethacin, drowsiness and confusion are possible.

When used simultaneously with carbamazepine, which is an inducer of microsomal liver enzymes, it is possible to increase the rate of metabolism of haloperidol. Haloperidol may increase plasma concentrations of carbamazepine. Symptoms of neurotoxicity may occur.

With simultaneous use, the therapeutic effect of levodopa and pergolide may be reduced due to blockade of dopamine receptors by haloperidol.

When used simultaneously with methyldopa, sedation, depression, dementia, confusion, and dizziness are possible; with morphine - myoclonus may develop; with rifampicin, phenytoin, phenobarbital - a decrease in the concentration of haloperidol in the blood plasma is possible.

When used concomitantly with fluvoxamine, there are limited reports of a possible increase in the concentration of haloperidol in the blood plasma, which is accompanied by toxic effects.

When used simultaneously with fluoxetine, the development of extrapyramidal symptoms and dystonia is possible; with quinidine - an increase in the concentration of haloperidol in the blood plasma; with cisapride - prolongation of the QT interval on the ECG.

When used simultaneously with epinephrine, it is possible to “pervert” the pressor effect of epinephrine, and as a result, the development of severe arterial hypotension and tachycardia.

“In order not to worry, they are fed with haloperidol.” How people with dementia are helped in Russia

The higher the life expectancy in a country, the more people there are with dementia. Dementia is a disease of old age in which a person’s brain cells responsible for social skills and memory are destroyed. This process is irreversible. To prevent the life of an elderly person with dementia from simply waiting to die, they need the right care and concern. Present Time tells how people with dementia live in Russia, what difficulties they face, who helps them and how.

Information deficit

In Russia, few people know about dementia. Therefore, in 80% of cases, people simply do not notice the first signs of the disease in themselves or their loved ones. And when they notice, they often don’t understand what to do about it. Many people think: “Old age” - and do nothing.

To help people understand when to seek help, they need to be educated about what dementia is. “People have an information deficit. We do not have a social institute for working with dementia patients, the purpose of which would be to disseminate information about working with them and preventing the disease. In Europe, for example, targeted work is being carried out in this direction. Not only medical workers, but also representatives of professions working with older people know what dementia is,” said Senior Group clinical trainer Igor Poluboyartsev.

Senior Group is an organization that creates and maintains nursing homes, including for older people with dementia. The company's employees have been working with dementia patients for many years and know about the disease first-hand.

In the fall, the Senior Group organized the Memory Club, a school for relatives of people diagnosed with Alzheimer's disease or dementia disorders. At the meetings, experts will tell you how to properly communicate with dementia patients and how to care for them. The plans include activities for the elderly themselves: music and art therapy, watching movies, a conversation club.

Club meetings are held in the SMART library in Krylatskoye. There are practically no stairs or thresholds, annoying bright colors, and there is an elevator. So the library will be convenient not only for healthy school visitors, but also for the dementia patients themselves.

About 20 people came to the first Memory Club lecture. The majority are women. Men came for company with their wives and were mostly silent. When asked by the lecturer what they expected from the meeting, the listeners responded in a similar way: “Problems in communicating with my grandmother. I want to understand how to build communication with her.” Or: “After 90 years, my mother began to behave strangely. How to communicate with her?

Many people do not have the money to pay for an elderly person to stay in a good nursing home. That’s why people come to Memory Club: they hope that here they will be given the skills and knowledge that will help make the life of a person with dementia better and more comfortable.

In Russia there is practically no accessible environment for people facing dementia. And they need to communicate, meet, share experiences. In Moscow, the Memory Club could become such a place, the organizers believe.

Little oddities

Larisa is one of the visitors of the Memory Club. She was one of the first to come to the meeting and at first did not want to talk to the Present Time correspondent. The woman said that there was nothing special in her story.

Larisa’s mother is 86 years old, her father is no longer alive - he died eight years ago. Since then, Larisa and her sisters began to notice “strange things” about their mother. “At first we didn’t understand what was happening to her. They thought mom was joking. She began to forget what she was told literally ten minutes ago,” says Larisa. At the same time, my mother could easily talk about the events that took place during her youth.

Photo project by Ilya Nodia “A smile does not age.” Implemented in 2016 together with the Senior Group company

Clinical trainer Igor Poluboyartsev says that short-term memory impairment may be one of the first reasons to suspect dementia in an older person. “If I remember what I did ten years ago, but often cannot remember what I did 15 minutes ago, then this is the beginning of a dementia disorder,” Poluboyartsev said. Another warning sign is the loss of social skills, self-care skills and abilities that a person has had all his life. A person with dementia may forget how to use the most common things: keys, an umbrella or a spoon.

Previously, Larisa’s mother was great at crocheting, but now she has completely forgotten how. The woman also refuses to make entries in her diary, which she has kept for more than 40 years. Larisa says that physically her mother feels good. She takes care of herself, runs the house, works in the garden and plants vegetables. True, she forgets where she planted it.

Dementia and psychiatry

“From the outside you can’t say that mom is a sick person,” Larisa admits. She and her sisters visit their mother regularly, but as soon as they step outside the door, the woman begins to panic. “Mom calls everyone and asks why everyone abandoned her, why no one came for several days,” says Larisa. The neighbors have known about my mother’s illness for a long time. Someone says softly: memory has deteriorated. And someone said that the grandmother “went crazy.”

According to Igor Poluboyartsev, people with dementia in Russia are often perceived as mentally ill and therefore feared. The diagnosis of dementia is actually made by a psychiatrist. However, dementia patients are not mentally retarded people with an underdeveloped psyche. Dementia is the destruction of healthy brain tissue that occurs due to brain lesions such as Alzheimer's disease. This diagnosis, by the way, is made by a neurologist.

“A person may have healthy all organs, but because brain cells are destroyed, social functions, including self-care, suffer. Such people no longer fit into generally accepted social norms. And those who are different always arouse suspicion and fear in us,” says Poluboyartsev. Because of this, very little is said about dementia in Russia: people are afraid of facing public misunderstanding or even rejection.

Photo project by Ilya Nodia “A smile does not age.” Implemented in 2016 together with the Senior Group company

The head of the Memini project, Alexander Sonin, agrees that dementia in our country is most often hushed up. “They are ashamed of the diagnosis, that’s obvious. A person can calmly say that he has arthrosis or migraine. And about senile dementia is usually known only to a narrow circle of close relatives. Moreover, if you ask an American or a European whether he has ever encountered a dementia patient, the majority will answer in the affirmative,” says Sonin.

“Social Security suggested putting grandma in a mental hospital”

“Previously, patients with dementia were sent to psychoneurological boarding schools,” says Alexey Sidnev, CEO of Senior Group. “There is a constant shortage of staff, and people with dementia can be restless and need care. The job of the right institution is to understand the cause of the concern and work with it. When there is no one to work, drugs such as chlorpromazine and haloperidol are used. The patient then just sits and doesn’t want anything,” says Sidnev.

When Anna (the heroine’s name was changed at her request - NV) was offered to place her 83-year-old grandmother in a psychoneurological boarding school, the girl flatly refused. “Social security offered to put my grandmother in a mental health facility. Yes, she has dementia, but her head is fine! And you're suggesting that I put her in a madhouse? Yes, she will tell me: I’ll lie down for a week and die of hunger myself,” said Anna. The girl came to the Memory Club lecture to understand how she herself could help her grandmother when social security and health workers did not want to do this.

Anna's grandmother has been bedridden for three years due to a leg injury, so she cannot take care of herself or even eat food on her own. A nurse lives with her, whose salary costs her entire grandmother’s pension and some more money from relatives. Anna believes that her grandmother’s isolation and immobility accelerated the development of dementia. “Sometimes a grandmother asks when her grandson will come to her. And this grandson has already died,” said Anna.

React correctly

Clinical trainer Igor Poluboyartsev, in cases like Anna’s, advises not to tell a dementia patient that someone is no longer alive. This can upset the balance in the fragile world in which such people live, and lead to anxiety or even panic. It's better to distract grandma's attention. For example, give her an object that will evoke positive emotions, or ask her to tell a story from the past.

It is also absolutely forbidden to react with irritation to people with dementia. “Relatives usually have enough practical knowledge: how to bathe, feed, take a walk. But it is communication skills that are lacking. An elderly person in this condition needs care and understanding. After all, it’s not his fault that this happened to him,” Poluboyartsev said.

At the same time, the clinical trainer admits that reminding an old man every 15 minutes that you are his daughter is humanly tiring. Anna, for example, is constantly told by her grandmother the same stories. “She is an incredibly interesting person, but my nurse and I are finding it difficult to respond to her stories the way we used to. Volunteers and artists come to nursing homes and even hospices. We don’t have any of this, but my grandmother wants communication,” says Anna.

“A smile never ages” – photo project by Ilya Nodia

A disease that doesn't exist

The state is in no hurry to help dementia patients. “There are no official statistics on dementia, but there are data on Alzheimer's disease. It is the main cause of dementia disorders. There are approximately eight thousand Alzheimer's patients, according to official data for 2014. What is eight thousand on the scale of our country? Agree, the figure is ridiculous. Officials will not deal with this problem seriously,” says Memini head Alexander Sonin. According to experts, which were published in 2021 in the Journal of Neurology and Psychiatry by Professor Oleg Levin, about 1,700,000 Russians suffer from dementia.

Alexey Sidnev from Senior Group is also confident that reality is very different from the numbers on paper. “We know how to diagnose Alzheimer’s, but for some reason they don’t do it. After all, if you diagnose, you need to help,” says Sidnev. The situation is similar with nursing homes. “They will tell you that there are enough boarding houses because there is no queue. But it doesn’t exist, because they simply don’t put it in it. There was an order from the president to eliminate queues, and this is how it is being carried out,” said Sidnev.

There are also not enough geriatricians who deal with diseases of the elderly in Russia. “They have now begun to prepare them, but the process is slow. In recent years, we have trained about a hundred specialists,” adds Alexey Sidnev. So most often the problems of older people are dealt with by therapists or neurologists.

Larisa’s mother lives in the Saransk region, and the hospital tells her that memory problems are a natural process with which nothing can be done. “You need to be with her all the time, she asks for it. This is the only help she needs. I’m thinking of moving in with her and being with her all the time,” said Larisa. At Memory Club meetings, she hopes to learn how to properly care for her mother. Anna's situation is more complicated. Since her grandmother is bedridden, a nurse comes to their home and says: “Grandma is old, so she forgets everything.” Anna cannot buy medications that could slow down the changes in dementia without a doctor’s prescription. A neurologist or psychiatrist cannot come to your home - it’s not allowed.

Alexander Sonin says that doctors are skeptical about anti-dementia therapy. “We know that Alzheimer’s disease is currently incurable, so doctors who do not have special education do not believe in the effect of medications. They often say to relatives: “Do you have extra money?” - and they don’t write anything out. They are convinced that they are doing the right thing,” says Alexander Sonin. However, research shows that medications slow the progression of the disease and help delay the progression of dementia.

Nursing homes today

In fact, dementia does not seem to exist in Russia. For families facing illness, social services can do virtually nothing to help. At most, they will bring food to an elderly person several times a week. But the reality is that it is often simply dangerous to leave dementia patients alone. In such cases, the solution may be a boarding house, where specially trained staff are able to provide the patient with proper care. This pleasure is not cheap - a good non-state nursing home costs four to five thousand a day.

In geriatric

“In government nursing homes, people live five to six people per room, with toilets and bathrooms on the floor. Guests shower once a week or less. In addition, all such establishments were built for people who are more or less independent. Those diagnosed with dementia, who find it difficult to move independently due to injury, need completely different care,” said Alexey Sidnev.

Sometimes relatives of the sick have to simply quit their jobs and devote themselves entirely to caring for the elderly person.

A national plan for helping dementia patients will appear in Russia

Today in Russia there is no plan to protect patients with dementia and their families, says Alexander Sonin. “Two years ago, WHO called on all countries to adopt such a plan, and Russia was one of the first to respond. A working group was created, they have already drawn up their program. But so far this initiative is being discussed with a certain amount of skepticism,” says Sonin. After all, all this requires money.

Present Time turned to the chief geriatrician of the Russian Ministry of Health, Olga Tkacheva, for comment. As part of an expert group, she is working to create a national plan for helping people with dementia.

“The plan has actually already been developed, and its final version will be signed by the Ministry of Health in December as part of the national project “Demography.” Then it will be sent to the regions, published in medical journals, and on the website of the Ministry of Health itself. The active implementation of the plan in the work of medical and social services will begin,” Tkacheva said.

The document outlines a system of long-term care for people with dementia. Tools are provided to help identify cognitive impairment in an elderly person. It is said which doctor to contact in case of illness and what kind of help this doctor should provide.

According to the geriatrician, there is no need for the construction of new specialized boarding houses and nursing homes. “There is absolutely no need to invent new entities. The system we are talking about should be implemented in the work of all clinics and hospitals. Wherever elderly patients are treated, they must identify these problems and be able to solve them,” Tkacheva said.

Also, she believes, the topic of dementia should be updated in people’s consciousness and in education.

In geriatric

What else can the government do?

According to the head of Memini, the state can do very little well. Therefore, his task is to give freedom to businessmen who are able to offer care services to families with dementia patients, and simply control their activities. And also financially support those people who cannot pay for their treatment or stay in a boarding house.

Alexey Sidnev from Senior Group says that the state today actually takes on part of the costs of maintaining a dementia patient in a boarding house. But to receive this subsidy, you need to work hard: even for experienced lawyers it takes up to four months. “On average, the state pays 2,300 rubles per day per person. The cost of providing high-quality services in a special center for seriously ill people is no less than 4500-5000 rubles per day. But you still need to earn money,” says Sidnev.

According to him, providing services to older people is a difficult and low-profit business, and therefore unpopular. However, the need for it is enormous. There are more and more elderly people in Russia every year, which means that the number of dementia patients will increase. The state’s task is to create a system of boarding houses in which people would pay 45,000 rubles a month to stay and receive good, proper care, Sidnev believes.

In geriatric

Information work is also important, says clinical trainer Igor Poluboyartsev. If people know what dementia is, they will notice its manifestations earlier, which means they will seek help in time. “In European countries there are programs to prevent dementia in people over 65 years of age. They also conduct screening for the likelihood of disease. If the diagnosis is confirmed, the work of specialists begins - doctors, social workers, geriatric nurses and psychologists. Dementia is a problem that can be solved by a whole team of specialists; only a doctor will be of little help,” says Poluboyartsev.

“If they talk about dementia, then people will at least stop being ashamed of it,” says Larisa. – We need to talk about this. Otherwise they always show on TV: look how cheerful the old people are, how great they feel. But in reality everything is different. Just because grandma goes somewhere doesn’t mean she knows where to go.”

Source: © Present Tense

Correction of complications

Withdrawal syndrome is prevented by a slow reduction in the dose of Haloperidol. This action allows you to avoid increased resistance of CNS receptors and painlessly overcome the end of the course of treatment. If a problem is formed, the following actions are used:

Replacing Haloperidol with a new antipsychotic drug not previously taken by the patient while simultaneously reducing the dose of the “old” drug.
Prescription of auxiliary medications - antidepressants, tranquilizers and nootropics.
In difficult clinical situations - purification of the blood from Haloperidol metabolites using infusion therapy and plasmapheresis.
Symptomatic treatment is the prescription of beta blockers to correct complications of the heart and blood vessels (Atenolol, Anaprilin), anticholinergic drugs to eliminate extrapyramidal disorders (Atropine, Biperiden) and benzodiazepines to relieve neurological and mental disorders (Diazepam, Midosalam).

Interaction with alcohol

Any medications should absolutely not be combined with alcohol. In the case of haloperidol, this combination can lead to the most unexpected consequences. Often in such cases there are:

a sharp increase in painful symptoms;
disorders of the cardiovascular system;
enhancing personal changes;
depression of respiratory functions, which leads to coma and death;
disorientation in space and time.

While being treated with this antipsychotic, you should not drive, engage in activities that require increased concentration, or operate machinery that requires complex maintenance.

Haloperidol is an effective antipsychotic that is widely used in alcoholic psychosis. It can only be used as prescribed by a doctor in specialized institutions that treat alcoholism and drug addiction.

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Experts' opinion

Most doctors believe that the drug has shown good results over many years of use. It successfully relieves a person from the manifestations of the disease with major and borderline mental disorders. And all the side effects of the drug have been well studied and can be predicted.

To obtain a therapeutic effect and avoid complications, you should never take an antipsychotic without control. Only a specialist can fully calculate the harm and benefit that the drug brings and select the dosage. If you do not take into account contraindications and do not follow the instructions of the treating doctor, overestimating the recommended dose, you cannot exclude a high risk of complications. They will certainly manifest themselves with negative symptoms with multiple disorders of the mental state and functioning of internal organs.

Use of the drug in the clinic

The medicine is used for short-term use, only in specialized clinics. The features of its use are as follows:

the dosage is selected by the doctor individually, starting with small doses;
the patient is monitored 24 hours a day in the hospital during admission;
Physiological functions (pressure, body temperature, glucose levels, etc.) are regularly monitored;
doctors and nurses keep a sheet recording the patient’s condition;
The attending physician additionally prescribes medications that protect against the side effects of the antipsychotic.

Haloperidol is discontinued as soon as the patient's condition has stabilized. Long-term use is possible only in case of resistant schizophrenia, when the patient’s delusions and hallucinations do not disappear.

Side effects and contraindications

After taking haloperidol, side effects are observed when:

Parkinson's disease and epilepsy: causes increased tremor, increases muscle hypertonicity;
pregnancy and breastfeeding: inhibits fetal development, can cause extrapyramidal symptoms;
vegetative-vascular dystonia and low blood pressure: this can lead to hypokinesia, vegetative crisis;
severe depression of the nervous system: stroke, coma, drug overdose.

In addition, the medicine should not be used together with other sedatives. This can cause an increased depressive effect on the nervous system, leading to respiratory arrest and sometimes coma.

Features and symptoms

To relieve such disorders, various medications are used: sedatives, psychotropics, antipsychotics.

One of the most common and terrible consequences is delirium. For its treatment, haloperidol is used in tablets or drops. The condition after abruptly quitting alcohol the day before is characterized by the following symptoms:

disorientation in space and time;
convulsive seizures, tremors of limbs;
mood swings, especially in the evenings;
panic attacks, anxiety, increased aggressiveness;
the occurrence of hallucinations of various types;
increased body temperature, tachycardia, arrhythmia, pale skin, increased blood pressure, etc.

This condition should be treated only in medical clinics under the supervision of experienced specialists. Otherwise, you can provoke serious consequences, even death.

Symptoms

Haloperidol withdrawal syndrome is accompanied by specific symptoms. Anxiety and stress during cessation of treatment with antipsychotic drugs increase the risk of developing pathology or aggravate its course. Let's consider the key clinical manifestations of withdrawal syndrome.

Hypersensitivity psychosis

The condition is associated with increased sensitivity of dopamine receptors. The reaction is caused by an exacerbation of the primary mental disorder for which treatment with Haloperidol was carried out. Often, dopamine receptor hypersensitivity psychosis is combined with other pathologies, for example, tardive dyskinesia. The main symptoms are increased excitability, irritability, and outbursts of aggression. Laboratory tests often show an increase in the level of prolactin in the blood. The risk of hypersensitivity psychosis persists for several months after discontinuation of Haloperidol.

Tardive dyskinesia

It develops against the background of increased resistance of dopamine receptors in the nigrostriatal zone of the central nervous system due to prolonged treatment with antipsychotics and an imbalance between the levels of dopamine and acetylcholine in the basal ganglia. The clinical picture is characterized by dystonic or choreiform dyskinesias, withdrawal akathisia, etc.

The main symptoms are involuntary movements of the limbs and muscles in the form of nervous tics, tremor, trembling, and muscle spasms. Patients may blink frequently, repeat chewing movements, smack their lips, and unusual vocalizations and spasmodic torticollis are less common. Loss of motor control and frequent seizures complicate the problem. Tardive dyskinesia is diagnosed 2-3 days after stopping treatment.

Cholinergic rebound syndrome

Develops in response to abrupt withdrawal of Haloperidol. The condition occurs in response to an increase in the resistance of not only dopamine but also muscurinic receptors. Key symptoms are nausea, increased anxiety, sleep disorders and extrapyramidal disorders.

Cholinergic rebound syndrome may occur in patients taking antipsychotics concomitantly with anticholinergic drugs. This combination makes it possible to correct the side effects of neuroleptic therapy. The condition is prevented by slow withdrawal of Haloperidol and taking anticholinergic drugs for 1-2 weeks after stopping treatment.

"Early activation"

A relatively new term in psychiatry, meaning increased motor and mental activity in response to abrupt withdrawal of Haloperidol. The clinical picture of “early activation” is based on the withdrawal of the antipsychotic drug and the associated blockade of histamine H1 receptors. The main symptoms are aggression towards others, insomnia, excess energy.

Typically, the listed manifestations were regarded as a stimulating effect of the new drug and signs of worsening psychosis, which is extremely undesirable for patients. But at the same time, “early activation” must also be considered from the point of view of stopping treatment with Haloperidol as a negative consequence of withdrawal syndrome. That is, a differential diagnosis of “early activation” and psychomotor agitation, akathisia, and suppression of the sedative effect on the central nervous system is necessary.

Nonspecific clinical picture

Sometimes the symptoms of Haloperidol withdrawal syndrome are not similar to the clinical manifestations listed above. Experts explain this phenomenon by the individual reaction of the central nervous system to drug withdrawal. Patients complain of headaches and dizziness, problems with the functioning of the gastrointestinal tract, sweating and weakness. Most often, withdrawal syndrome is observed in the first 4-7 days after stopping the drug. Its maximum duration is 4 weeks. The severity of manifestations depends on the duration of treatment with Haloperidol. Sometimes pathology occurs after a short course of treatment.

Treatment

The drug haloperidol is an antipsychotic drug that has a pronounced antipsychotic effect. It causes inhibition of the reflexes of the central nervous system, due to which it is successfully used to treat delirium tremens, manic and delusional states, hallucinatory disorders, etc.

The drug is used during addiction treatment, it allows you to minimize the risk of developing psychosis, as well as relieve associated symptoms: vomiting, nausea, fever and others. Also, with its help, you can get rid of hallucinations and delusions in a short time.