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Drug Interactions between Haldol Decanoate and lithium

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

haloperidol lithium

Applies to: Haldol Decanoate (haloperidol) and lithium

MONITOR CLOSELY: Haloperidol can cause dose-related prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may result in elevated risk of ventricular arrhythmias, including ventricular tachycardia and torsade de pointes, because of additive arrhythmogenic potential related to their effects on cardiac conduction. Haloperidol treatment alone has been associated with a number of reported cases of torsade de pointes and sudden death. The majority of cases involved intravenous administration or use of higher than recommended dosages. Lithium has also been reported to prolong the QT interval in some patients. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drugs involved and dosages of the drugs.

MONITOR CLOSELY: Although haloperidol and lithium have been used safely together in many patients, there have been a few reported cases of encephalopathic syndrome consisting of severe neurotoxic effects and extrapyramidal symptoms, followed by irreversible brain damage, associated with the combination. The mechanism is unknown.

MANAGEMENT: Caution is advised if haloperidol is used in combination with lithium, particularly when administered intravenously (not approved by the FDA) or at higher than recommended dosages. Large doses of both drugs should generally be avoided. Some clinicians have recommended reducing the haloperidol dosage when lithium is initiated. Patients should be followed closely for evidence of neurotoxicity, especially during the first few weeks of therapy. Therapy should be discontinued if potential signs and symptoms of encephalopathic syndrome develop, including weakness, fever, lethargy, tremulousness, confusion, extrapyramidal symptoms, leukocytosis, and elevations in serum enzymes, BUN and fasting blood sugar. In addition, patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsades de pointes such as dizziness, palpitations, or syncope.

References (12)
  1. Addonizio G (1985) "Rapid induction of extrapyramidal side effects with combined use of lithium and neuroleptics." J Clin Psychopharmacol, 5, p. 296-8
  2. Goldney RD, Spence ND (1986) "Safety of the combination of lithium and neuroleptic drugs." Am J Psychiatry, 143, p. 882-4
  3. Spring G, Frankel M (1981) "New data on lithium and haloperidol incompatibility." Am J Psychiatry, 138, p. 818-21
  4. Cohen WJ, Cohen NH (1974) "Lithium carbonate, haloperidol, and irreversible brain damage." JAMA, 230, p. 1283-7
  5. Baastrup PC, Hollnagel P, Sorensen R, Schou M (1976) "Adverse reactions in treatment with lithium carbonate and haloperidol." JAMA, 236, p. 2645-6
  6. Miller F, Menninger J (1987) "Correlation of neuroleptic dose and neurotoxicity in patients given lithium and a neuroleptic." Hosp Community Psychiatry, 38, p. 1219-21
  7. Thomas CJ (1979) "Brain damage with lithium/haloperidol." Br J Psychiatry, 134, p. 552
  8. (2002) "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical
  9. (2002) "Product Information. Eskalith (lithium)." SmithKline Beecham
  10. Liberatore MA, Robinson DS (1984) "Torsade de pointes: a mechanism for sudden death associated with neuroleptic drug therapy?" J Clin Psychopharmacol, 4, p. 143-6
  11. Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SH (2000) "QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients." Lancet, 355, p. 1048-52
  12. Sala M, Vicentini A, Brambilla P, et al. (2005) "QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy." Ann Gen Psychiatry, 4, p. 1

Drug and food interactions

Moderate

haloperidol food

Applies to: Haldol Decanoate (haloperidol)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
Moderate

lithium food

Applies to: lithium

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
Moderate

lithium food

Applies to: lithium

MONITOR: One study has suggested that caffeine withdrawal may significantly increase blood lithium levels. The mechanism may be involve reversal of a caffeine-induced increase in renal lithium excretion.

MANAGEMENT: When caffeine is eliminated from the diet of lithium-treated patients, caution should be exercised. When caffeine consumption is decreased, close observation for evidence of lithium toxicity and worsening of the psychiatric disorder is recommended. Patients should be advised to notify their physician if they experience symptoms of possible lithium toxicity such as drowsiness, dizziness, weakness, ataxia, tremor, vomiting, diarrhea, thirst, blurry vision, tinnitus, or increased urination.

References (1)
  1. Mester R, Toren P, Mizrachi I, Wolmer L, Karni N, Weizman A (1995) "Caffeine withdrawal increases lithium blood levels." Biol Psychiatry, 37, p. 348-50
Moderate

haloperidol food

Applies to: Haldol Decanoate (haloperidol)

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

References (4)
  1. (2024) "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd
  2. jeong sh, Newcombe D, sheridan j, Tingle M (2015) "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal, 7, p. 475-82
  3. Vaughan DP, Beckett AH, Robbie DS (1976) "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol, 3, p. 279-83
  4. Zevin S, Benowitz NL (1999) "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet, 36, p. 425-38

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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