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Michael W Jann - One of the best experts on this subject based on the ideXlab platform.
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Haloperidol and reduced Haloperidol plasma concentrations after a loading dose regimen with Haloperidol Decanoate
Progress in Neuro-psychopharmacology & Biological Psychiatry, 1996Co-Authors: Michael W Jann, F C Wei, Hsinnan Lin, C Piaochien, Wenho ChangAbstract:1. Haloperidol and reduced Haloperidol plasma levels were measured in schizophrenic patients who received both oral (10 mg, N=16 and 20 mg, N=4) and depot Haloperidol treatment 2. Patients were of Asian ethnicity and were safely and effectively converted from oral to depot therapy using a loading dose regimen using a 100 mg weekly injection interval for 4 weeks, biweekly for one month and then monthly. 3. Significant correlations were found for plasma Haloperidol and reduced Haloperidol levels and reduced Haloperidol/Haloperidol ratios between oral and depot therapy in these non-smoking patients. 4. A loading dose regimen is needed due to the long elimination half-life of Decanoate of 26 days otherwise steady-state condition will not occur until 34 months of therapy. 5. Patients were maintained on monthly depot treatment for 40 weeks after the loading dose regimen and only one patient relapsed during treatment despite dosage increases. 6. The formation of reduced Haloperidol remained consistent for oral and depot Haloperidol treatment.
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disposition of Haloperidol and reduced Haloperidol plasma levels after single dose Haloperidol Decanoate administration
Human Psychopharmacology-clinical and Experimental, 1995Co-Authors: Wenho Chang, Dongjuiing Juang, Shihku Lin, Jinding Huang, Yw Francis Lam, Michael W Jann, Chingpiao ChienAbstract:A single dose of Haloperidol Decanoate 100 mg was administered to 15 schizophrenic patients. Blood samples were obtained prior to injection, 1 h, 3 h, 6 h, 8 h, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, one week, two weeks, three weeks and four weeks post-injection. Haloperidol and its reduced metabolite, reduced Haloperidol, plasma levels were assayed by HPLC with electrochemical detection. The pharmacokinetic parameters of Haloperidol were determined. The mean time of maximal (Tmax) plasma levels for Haloperidol was 5·73 ± 0·80 days. The Haloperidol plasma levels showed a biexponential decline with an elimination half-life of 15·78 ± 5·90 days. Reduced Haloperidol was rapidly formed from the Haloperidol. The Tmax of reduced Haloperidol was 7·00 ± 2·35 days. The mean ratio reduced Haloperidol/Haloperidol was 0·155 ± 0·111. Since the Tmax occurs at approximately six days, a weekly loading dose of Haloperidol Decanoate is feasible during the transition from oral to depot therapy.
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effects of Haloperidol Decanoate on plasma homovanillic acid in chronic schizophrenic patients
Biological Psychiatry, 1993Co-Authors: Wenho Chang, Dongjuiing Juang, Shihku Lin, Li Ching Chen, Chih Hsien Yang, Hsienyuan Lane, Michael W JannAbstract:The effects of acute and chronic oral antipsychotic treatment on plasma homovanillic acid (pHVA) have been extensively studied over the past several years, However, the pHVA response to depot preparations remains unknown. This study reports an elevation in pHVA after Haloperidol Decanoate (HLD) administration in chronic schizophrenic patients. Thirteen stable chronic schizophrenic patients diagnosed by DSM-III-R criteria participated in th~s study. Informed consent was obtained from each patient. The study consisted of nine men and four women with a mean age of 37.2 -+ 6,9 years and weight of 61.3 --10.0 kg, These patients had been institutionalized at Chingyang Psychiatric Hospital for 9.0 --7.0 years and had been free of oral neuroleptics for at least 4 weeks and free of depot neuroleptics for at least 6 months prior to beginning the study. All subjects were placed on a low-monoamine diet and received noncaffeinated and nonalcoholic beverages for 4 weeks prior to and during the study. Intramuscular injections of HLD (Haldol decanoas) 100 mg were given every 4 weeks. After five injections, HLD was discontinued. The only concurrent medications were trihexyphenidyl (4 mg/day) and nitrazepam (5 rag/day), which do not influence Haloperidol (HL) plasma concentrations (Cps) (Froemming et al 1989) and has not been reported to change pHVA levels. Venous blood was sampled on days 0 (baseline), 2 and 4, and the end of weeks 1 , 2 , 3 , 4 . 5 . 6 , 7 , 8 , 9 , 10, 11, 12, 13, 14, 15, 16, 17, 19, 20, 21, 23, 25, 27, and 29. Blood samples were collected into ethylenediaminetetraacetic acid (ETDA) tubes, and plasma was separated by a centrifuge at 3,000 RPM for 15 min. All specimens were kept at 50 ° C until assayed. Cps of HVA and HI, were determined with high performance liquid chro-
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reduced Haloperidol Haloperidol ratios after oral Haloperidol and Decanoate administration in schizophrenics
Progress in Neuro-psychopharmacology & Biological Psychiatry, 1993Co-Authors: Chang Wehho, Yw Francis Lam, Lin Shihku, Juang Dongjuiing, Chen Lichen, Yang Chihhsien, Hu Weiherng, Chien Chingpiao, Michael W JannAbstract:Abstract 1. Haloperidol and reduced Haloperidol plasma concentrations were measured in thirteen stable schizophrenic patients that received both oral Haloperidol and Haloperidol Decanoate. 2. Significant correlations between reduced Haloperidol/Haloperidol ratios from oral Haloperidol and Haloperidol Decanoate occurred at week two and week 16, respectively. 3. The formation of RH was consistent during Haloperidol Decanoate treatment.
Wenho Chang - One of the best experts on this subject based on the ideXlab platform.
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Haloperidol and reduced Haloperidol plasma concentrations after a loading dose regimen with Haloperidol Decanoate
Progress in Neuro-psychopharmacology & Biological Psychiatry, 1996Co-Authors: Michael W Jann, F C Wei, Hsinnan Lin, C Piaochien, Wenho ChangAbstract:1. Haloperidol and reduced Haloperidol plasma levels were measured in schizophrenic patients who received both oral (10 mg, N=16 and 20 mg, N=4) and depot Haloperidol treatment 2. Patients were of Asian ethnicity and were safely and effectively converted from oral to depot therapy using a loading dose regimen using a 100 mg weekly injection interval for 4 weeks, biweekly for one month and then monthly. 3. Significant correlations were found for plasma Haloperidol and reduced Haloperidol levels and reduced Haloperidol/Haloperidol ratios between oral and depot therapy in these non-smoking patients. 4. A loading dose regimen is needed due to the long elimination half-life of Decanoate of 26 days otherwise steady-state condition will not occur until 34 months of therapy. 5. Patients were maintained on monthly depot treatment for 40 weeks after the loading dose regimen and only one patient relapsed during treatment despite dosage increases. 6. The formation of reduced Haloperidol remained consistent for oral and depot Haloperidol treatment.
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disposition of Haloperidol and reduced Haloperidol plasma levels after single dose Haloperidol Decanoate administration
Human Psychopharmacology-clinical and Experimental, 1995Co-Authors: Wenho Chang, Dongjuiing Juang, Shihku Lin, Jinding Huang, Yw Francis Lam, Michael W Jann, Chingpiao ChienAbstract:A single dose of Haloperidol Decanoate 100 mg was administered to 15 schizophrenic patients. Blood samples were obtained prior to injection, 1 h, 3 h, 6 h, 8 h, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, one week, two weeks, three weeks and four weeks post-injection. Haloperidol and its reduced metabolite, reduced Haloperidol, plasma levels were assayed by HPLC with electrochemical detection. The pharmacokinetic parameters of Haloperidol were determined. The mean time of maximal (Tmax) plasma levels for Haloperidol was 5·73 ± 0·80 days. The Haloperidol plasma levels showed a biexponential decline with an elimination half-life of 15·78 ± 5·90 days. Reduced Haloperidol was rapidly formed from the Haloperidol. The Tmax of reduced Haloperidol was 7·00 ± 2·35 days. The mean ratio reduced Haloperidol/Haloperidol was 0·155 ± 0·111. Since the Tmax occurs at approximately six days, a weekly loading dose of Haloperidol Decanoate is feasible during the transition from oral to depot therapy.
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effects of Haloperidol Decanoate on plasma homovanillic acid in chronic schizophrenic patients
Biological Psychiatry, 1993Co-Authors: Wenho Chang, Dongjuiing Juang, Shihku Lin, Li Ching Chen, Chih Hsien Yang, Hsienyuan Lane, Michael W JannAbstract:The effects of acute and chronic oral antipsychotic treatment on plasma homovanillic acid (pHVA) have been extensively studied over the past several years, However, the pHVA response to depot preparations remains unknown. This study reports an elevation in pHVA after Haloperidol Decanoate (HLD) administration in chronic schizophrenic patients. Thirteen stable chronic schizophrenic patients diagnosed by DSM-III-R criteria participated in th~s study. Informed consent was obtained from each patient. The study consisted of nine men and four women with a mean age of 37.2 -+ 6,9 years and weight of 61.3 --10.0 kg, These patients had been institutionalized at Chingyang Psychiatric Hospital for 9.0 --7.0 years and had been free of oral neuroleptics for at least 4 weeks and free of depot neuroleptics for at least 6 months prior to beginning the study. All subjects were placed on a low-monoamine diet and received noncaffeinated and nonalcoholic beverages for 4 weeks prior to and during the study. Intramuscular injections of HLD (Haldol decanoas) 100 mg were given every 4 weeks. After five injections, HLD was discontinued. The only concurrent medications were trihexyphenidyl (4 mg/day) and nitrazepam (5 rag/day), which do not influence Haloperidol (HL) plasma concentrations (Cps) (Froemming et al 1989) and has not been reported to change pHVA levels. Venous blood was sampled on days 0 (baseline), 2 and 4, and the end of weeks 1 , 2 , 3 , 4 . 5 . 6 , 7 , 8 , 9 , 10, 11, 12, 13, 14, 15, 16, 17, 19, 20, 21, 23, 25, 27, and 29. Blood samples were collected into ethylenediaminetetraacetic acid (ETDA) tubes, and plasma was separated by a centrifuge at 3,000 RPM for 15 min. All specimens were kept at 50 ° C until assayed. Cps of HVA and HI, were determined with high performance liquid chro-
Sabish Balan - One of the best experts on this subject based on the ideXlab platform.
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Haloperidol Decanoate induced pancytopenia a case report
American Journal of Geriatric Psychiatry, 2020Co-Authors: Amit Jagtiani, Sandra Veigne, Elisabeth Lescouflair, Sabish BalanAbstract:Introduction Blood dyscrasias can occur secondary to antipsychotic drug use which may be due to direct drug toxicity or immunologic mechanisms causing bone marrow suppression. Antipsychotic use mostly causes neutropenia and less frequently thrombocytopenia. Drug-induced pancytopenia is a very rare side-effect of psychotropic medications and is even rarer with butyrophenones like Haloperidol Methods We reviewed the case of a geriatric patient who developed pancytopenia while on Haloperidol Decanoate monthly injection Results We present the case of an 85-year-old African-American woman with a long history of schizophrenia, who was stabilized on Haloperidol Decanoate 50?mg monthly IM for a few years at another hospital. She was then maintained on the Haloperidol Decanoate for a few months after she moved outpatient care to our hospital. She was noted to have pancytopenia at initial presentation in the clinic and her RBC, Platelets, and WBC (including neutrophil) counts gradually declined to the point where her Haloperidol Decanoate was placed on hold in order to further monitor the blood counts. Baseline leukocyte count was 3000/mm³ when she started outpatient treatment at our clinic, which gradually dropped to 1860/mm³ within 6 months of Haloperidol Decanoate treatment. During this time, hemoglobin dropped 0.8 points (10.9?g/?dL to 10.1 g/dL), and platelet count decreased from 154,000/mm3 to 140,000/mm3. Within one month of discontinuation of Haloperidol Decanoate, patient decompensated and was admitted to the psychiatry inpatient unit. Hematology was consulted; lab work to exclude other causes of pancytopenia was completed and Haloperidol induced pancytopenia was suspected. She didn't receive any more Haloperidol Decanoate during her hospital stay. She consistently refused oral medications and became catatonic. Court order for medication-over-objection was obtained but she continued refusing oral medications. As a result, she received Olanzapine 5?mg IM consistently for few days which ultimately resulted in clinical improvement. She was discharged after 2 months of inpatient stay. Her cell counts gradually trended upwards during the inpatient stay. At the time of discharge from the inpatient unit, her WBC count had increased to 5100/mm3, hemoglobin increased to 11.2?g/?dL, and platelet count remained stable at 138000/mm3. It took roughly three months, after stopping the Haloperidol Decanoate, for the counts to normalize. Conclusions Blood dyscrasias should be suspected in patients treated with antipsychotics. Patients on long acting depot antipsychotics might need longer time to recover from blood dyscrasias due to slow wash-out of depot preparations This research was funded by: Not Applicable
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clinical challenges in the management of an 85 year old patient with a long history of schizophrenia and non compliance who developed Haloperidol Decanoate induced pancytopenia
American Journal of Geriatric Psychiatry, 2020Co-Authors: Amit Jagtiani, Sandra Veigne, Elisabeth Lescouflair, Sabish BalanAbstract:Introduction Management of psychosis in elderly patients is complicated because of the numerous medical comorbidities and increased susceptibility to side effects of psychotropics in this population. Management of psychosis can be further complicated by a variety of psychosocial factors. Methods We reviewed the case of a non-compliant geriatric patient who developed pancytopenia while on Haloperidol Decanoate monthly injection and clinical challenges we faced regarding her management on the psychiatric inpatient unit. Results We present the case of an 85-year-old African-American woman with a long history of schizophrenia, who was stabilized on Haloperidol Decanoate 50?mg monthly IM for a few years at another hospital. She developed pancytopenia while on Haloperidol Decanoate and relapsed within a month after stopping the injection resulting in hospitalization at our inpatient unit. At initial presentation, she was catatonic and had poor oral intake resulting in acute renal injury, requiring stabilization in the medical unit. Subsequently, the patient was transferred to the psychiatry inpatient unit where she continued to refuse food and medications due to delusional paranoid beliefs. Hematology was consulted; lab work to exclude other causes of pancytopenia was completed and Haloperidol induced pancytopenia was suspected. She didn't receive any more Haloperidol Decanoate during her hospital stay and continued to refuse all medications offered. Due to poor compliance on medications in the unit and continued deterioration of her medical condition, a court order was obtained for medication-over-objection, however, patient refused to comply with that too. Due to the risk of pancytopenia with Haloperidol, very slow recovery from the bone marrow suppression due to slow wash-out of the long acting antipsychotic, and the ongoing resistance of the patient to accept any medications, the clinical team had limited choices to offer in terms of choice of antipsychotic medications. She received olanzapine 5?mg IM daily for a few days as per court order, which resulted in some improvement in her clinical condition. She ultimately received Aripiprazole lauroxil before her discharge from the unit, with a limited challenge on oral aripiprazole prior to that to assess tolerability. Conclusions Management of schizophrenia in elderly can be very challenging and can be further complicated by side effects of medications and variety of psychosocial factors which need to be addressed for optimum outcomes. This research was funded by: Not applicable
Svante Nyberg - One of the best experts on this subject based on the ideXlab platform.
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delayed normalization of central d2 dopamine receptor availability after discontinuation of Haloperidol Decanoate preliminary findings
Archives of General Psychiatry, 1997Co-Authors: Svante Nyberg, Lars Farde, Christer HalldinAbstract:Background: Antipsychotic drugs in depot formulations may prevent psychotic relapses, even after complete withdrawal. To examine the duration of drug remaining in the brain, central D 2 dopamine receptor occupancy was measured with positron emission tomography for a year after discontinuation of depot neuroleptic treatment. Methods: Four schizophrenic patients were withdrawn from low-dose treatment with Haloperidol Decanoate (30-50 mg every 4 weeks). They were examined repeatedly with positron emission tomography and the radioligand carbon 11-labeled raclopride during the following year. At end point, a Scatchard analysis was performed to determine the density and affinity of D 2 dopamine receptors. Results: Occupancy of D 2 dopamine receptors was highest 1 week after depot injection (66%, 77%, 82%, and 78% in 4 patients) and then decreased slowly. Six months after discontinuation of treatment, D 2 dopamine receptor occupancy was 24%, 32%, and 34% in 3 patients. After 1 year, D 2 dopamine receptor density and affinity in 2 patients were within the ranges of control subjects, suggesting no remaining Haloperidol. Conclusions: Our preliminary finding of persistence of D 2 2 dopamine receptor occupancy indicates that commonly used doses of Haloperidol Decanoate (200 mg every 4 weeks) maintain antipsychotic levels of receptor occupancy even 16 weeks after discontinuation of treatment. This may explain the lower relapse rates in patients withdrawn from depot neuroleptic treatment compared with those with-drawn from oral treatment. In addition, the remaining occupancy may confound the clinical evaluation of subsequent treatments. For controlled clinical trials of new antipsychotic drugs, we suggest a minimum washout of 6 months after the last depot injection.
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d2 dopamine receptor occupancy during low dose treatment with Haloperidol Decanoate
American Journal of Psychiatry, 1995Co-Authors: Svante Nyberg, Lars Farde, Christer Halldin, M L Dahl, L BertilssonAbstract:Objectives: The aim of this study was to examine the relationships among clinical effects, central D 2 dopamine receptor occupancy, and plasma concentrations of Haloperidol in eight clinically stabilized schizophrenic outpatients who were responding to treatment with low doses of Haloperidol Decanoate. Method: During a 4-week interval of Haloperidol Decanoate dosage (dose range=30-50 mg), the patients' D 2 receptor occupancy was determined withpositron emission tomography on two occasions. Plasma concentrations of Haloperidol were determined with a sensitive high-performance liquid chromatography method. Results: One week after injection of Haloperidol Decanoate, the mean D 2 receptor occupancy was 73% (range=60%-82%), and the mean plasma concentration of Haloperidol was 4.6 nmol/liter (range=2.9-9.7). After 4 weeks, the mean D 2 receptor occupancy had decreased to 52% (range=20%-74%), and the mean Haloperidol concentration to 2.3 nmol/liter (range=1.0-4.4). Conclusions: The D 2 receptor occupancy 1 week after injection was high and comparable to that previously found in patients responding to acute treatment with classic neuroleptics. Prevention of relapse was maintained despite low D 2 receptor occupancy during the latter part of the treatment interval. These observations indicate that continuously high D 2 receptor occupancy may not be necessary to prevent schizophrenic relapses. The results emphasize the need for systematic clinical evaluation of intermittent low-dose treatment strategies
Christer Halldin - One of the best experts on this subject based on the ideXlab platform.
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delayed normalization of central d2 dopamine receptor availability after discontinuation of Haloperidol Decanoate preliminary findings
Archives of General Psychiatry, 1997Co-Authors: Svante Nyberg, Lars Farde, Christer HalldinAbstract:Background: Antipsychotic drugs in depot formulations may prevent psychotic relapses, even after complete withdrawal. To examine the duration of drug remaining in the brain, central D 2 dopamine receptor occupancy was measured with positron emission tomography for a year after discontinuation of depot neuroleptic treatment. Methods: Four schizophrenic patients were withdrawn from low-dose treatment with Haloperidol Decanoate (30-50 mg every 4 weeks). They were examined repeatedly with positron emission tomography and the radioligand carbon 11-labeled raclopride during the following year. At end point, a Scatchard analysis was performed to determine the density and affinity of D 2 dopamine receptors. Results: Occupancy of D 2 dopamine receptors was highest 1 week after depot injection (66%, 77%, 82%, and 78% in 4 patients) and then decreased slowly. Six months after discontinuation of treatment, D 2 dopamine receptor occupancy was 24%, 32%, and 34% in 3 patients. After 1 year, D 2 dopamine receptor density and affinity in 2 patients were within the ranges of control subjects, suggesting no remaining Haloperidol. Conclusions: Our preliminary finding of persistence of D 2 2 dopamine receptor occupancy indicates that commonly used doses of Haloperidol Decanoate (200 mg every 4 weeks) maintain antipsychotic levels of receptor occupancy even 16 weeks after discontinuation of treatment. This may explain the lower relapse rates in patients withdrawn from depot neuroleptic treatment compared with those with-drawn from oral treatment. In addition, the remaining occupancy may confound the clinical evaluation of subsequent treatments. For controlled clinical trials of new antipsychotic drugs, we suggest a minimum washout of 6 months after the last depot injection.
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d2 dopamine receptor occupancy during low dose treatment with Haloperidol Decanoate
American Journal of Psychiatry, 1995Co-Authors: Svante Nyberg, Lars Farde, Christer Halldin, M L Dahl, L BertilssonAbstract:Objectives: The aim of this study was to examine the relationships among clinical effects, central D 2 dopamine receptor occupancy, and plasma concentrations of Haloperidol in eight clinically stabilized schizophrenic outpatients who were responding to treatment with low doses of Haloperidol Decanoate. Method: During a 4-week interval of Haloperidol Decanoate dosage (dose range=30-50 mg), the patients' D 2 receptor occupancy was determined withpositron emission tomography on two occasions. Plasma concentrations of Haloperidol were determined with a sensitive high-performance liquid chromatography method. Results: One week after injection of Haloperidol Decanoate, the mean D 2 receptor occupancy was 73% (range=60%-82%), and the mean plasma concentration of Haloperidol was 4.6 nmol/liter (range=2.9-9.7). After 4 weeks, the mean D 2 receptor occupancy had decreased to 52% (range=20%-74%), and the mean Haloperidol concentration to 2.3 nmol/liter (range=1.0-4.4). Conclusions: The D 2 receptor occupancy 1 week after injection was high and comparable to that previously found in patients responding to acute treatment with classic neuroleptics. Prevention of relapse was maintained despite low D 2 receptor occupancy during the latter part of the treatment interval. These observations indicate that continuously high D 2 receptor occupancy may not be necessary to prevent schizophrenic relapses. The results emphasize the need for systematic clinical evaluation of intermittent low-dose treatment strategies
