Risperidone with Haloperidol Interaction Details
Brand Names Associated with Risperidone
- Risperdal® M-TAB® Orally Disintegrating Tablets
- Risperdal® Oral Solution
- Risperdal® Tablets
- Risperidone
Brand Names Associated with Haloperidol
- Haldol®
- Haloperidol
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
An increased risk of QT interval prolongation
Interaction Summary
Haloperidol is associated with QTc prolongation and torsade de pointes. Sometimes fatal QRS prolongation and QTc prolongation have been reported in patients taking risperiDONE therapeutically . An episode of QT prolongation was reported in a 46-year-old male after receiving risperiDONE and haloperidol . Therefore, caution is advised with the concomitant use of haloperidol and risperiDONE due to the potential for additive effects on QT interval prolongation and an increased risk of serious cardiovascular effects, including torsade de pointes . If concomitant therapy is required, monitor electrolytes and ECG for QT interval prolongation.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Caution is advised if haloperidol and risperiDONE are used concomitantly due to the potential for additive effects on QT interval prolongation and an increased risk for serious cardiovascular events, including torsade de pointes. If concomitant therapy is required, monitor electrolytes and ECG for QT interval prolongation.
Mechanism Of Interaction
Additive effects on QT interval prolongation
Literature Reports
A) Sometimes fatal QRS prolongation and QTc prolongation have been reported in patients taking risperiDONE therapeutically and in overdose situations .
B) Numerous case reports have described significant QTc prolongation and torsades de pointes (TdP) associated with haloperidol. Hemodynamically significant ventricular tachyarrhythmias, ventricular fibrillation, asystole, and death have been reported. The risk of TdP appears to be greater with intravenous haloperidol, but has occurred with oral and intramuscular use. The risk increases with doses greater than 35 milligrams (mg) over 24 hours, although TdP has been associated with a dose as low as 10 mg administered intravenously over 4 hours. To prevent haloperidol-induced TdP, screen patients for a history of dilated cardiomyopathy or alcohol abuse, testing for hypothyroidism before therapy, obtaining an electrocardiogram at baseline and throughout therapy, and monitoring potassium, magnesium, and calcium. In patients with a baseline QTc greater than 450 milliseconds (msec), haloperidol should be used cautiously or an alternative agent should be used. Discontinue haloperidol if the QTc increases more than 25% from baseline or if flattening of T-waves or development of U-waves occurs .
C) An episode of QT prolongation was reported in a 46-year-old male after receiving risperiDONE and haloperidol. The patient was admitted for overt psychosis and received risperiDONE 2 mg daily on days 1 and 2 of hospitalization. During admission, the patient became agitated and tachycardic (pulse rate of 124 beats per minute (bpm)) and received a one time dose of haloperidol 5 mg and lorazepam 2 mg to manage symptoms. Two hours later, the patient remained tachycardic (111 bpm) and an ECG revealed a QTc of 504 milliseconds (msec). The patient had no history of heart disease and an ECG obtained 4 months prior noted no such conduction delay. RisperiDONE and haloperidol were replaced with quetiapine 150 mg daily and a repeat ECG 3 days later showed sinus tachycardia (133 bpm) and a QTc of 451 msec. Daily ECGs were performed for 7 days, demonstrating normal QTc intervals. Electrolyte levels, thyroid function tests, as well as hepatic and cardiac enzymes were all unremarkable and no further signs of cardiac abnormalities were noted .
Risperidone Overview
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Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
Haloperidol Overview
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Haloperidol is used to treat psychotic disorders (conditions that cause difficulty telling the difference between things or ideas that are real and things or ideas that are not real). Haloperidol is also used to control motor tics (uncontrollable need to repeat certain body movements) and verbal tics (uncontrollable need to repeat sounds or words) in adults and children who have Tourette's disorder (condition characterized by motor or verbal tics). Haloperidol is also used to treat severe behavioral problems such as explosive, aggressive behavior or hyperactivity in children who cannot be treated with psychotherapy or with other medications. Haloperidol is in a group of medications called conventional antipsychotics. It works by decreasing abnormal excitement in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.