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Parkinson's and Haldol


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#1 JimH

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Posted 06 March 2011 - 02:17 PM

Hi all, I have a question please:

Patient lived on his own with stage 2 PD, tripped and broke his hip, had a pin placed in his hip on Thursday, surgery was 1 hour, came out of PACU agitated was given Haldol oral on Thursday and Friday and Saturday was given Haldol IV push, Sunday morning was taken to ICU with this:
Tachypneic, Tachycardiac, Hypoxemic, aspiration, Sepsis. emergent intubation, chest X-ray shows mild congestive heart failure. Impression: Hypoxemic respiratory failure, differential would include pulmonary edema and aspiration pneumonitis, arrhythmia.

No prior history of heart or respiratory problems


Is it possible the Haldol caused it.

#2 Dr. Okun

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Posted 07 March 2011 - 07:25 AM

Caused? Well that is unclear. Contributed? Possibly.

Haldol and dopamine blockers should usually not be given in PD because they may worsen symptoms.

Those coming out of surgery and taken off the PD meds can develop a syndrome called neuroleptic malignant syndrome--it is important to restart PD meds. Giving a dopamine blocker can further exacerbate this risk, worsen PD symptoms and place patients at risk for aspiration pneumonia.

Hope that helps.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#3 JimH

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Posted 07 March 2011 - 12:52 PM

Caused? Well that is unclear. Contributed? Possibly.

Haldol and dopamine blockers should usually not be given in PD because they may worsen symptoms.

Those coming out of surgery and taken off the PD meds can develop a syndrome called neuroleptic malignant syndrome--it is important to restart PD meds. Giving a dopamine blocker can further exacerbate this risk, worsen PD symptoms and place patients at risk for aspiration pneumonia.

Hope that helps.

Thank you Dr. Okun, you are helping me get an understanding of what happened here, like I mentioned the patient went to ICU on Sunday, got back to a regular room on Wednesday, completely immobile, was seen for the first time Thursday by a Neurologist, who said he had severely advanced PD he then died the following Monday morning.


Death cert reads
1. Minutes: Cardiopulmonary Arrest
2. Days: Aspiration Pneumonia
3. Years Advanced Parkinson's Disease
Other conditions contributing to death:
Congestive Heart Failure, Dysphagia

I just can't understand how his PD could have advanced so rapidly if not for the Haldol, 10 days prior to the hospital he lived alone, drove a car, shopped for food, cooked, cleaned and took daily walks.

I understand Haldol is not to be administered IV let alone pushed, do you know why?

Can you expand more on NMS.

Thank You for your knowledge and help, you comments undoubtedly help many who visit this wonderful informative site.

#4 Dr. Okun

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Posted 10 March 2011 - 07:47 AM

I am so sorry for your loss. It is hard to understand specifically what happened as every situation has details and there are issues that may emerge while hospitalized. Again, I am so sorry for your loss.

Haldol is typically given orally (by mouth).

There is a FDA warning on Haldol publicly available (this one I took from drugs.com)

WARNING

Increased Mortality in Elderly Patients with Dementia-Related Psychosis

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Haloperidol is not approved for the treatment of patients with dementia-related psychosis (see WARNINGS).
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#5 JimH

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Posted 10 March 2011 - 01:17 PM

Thank You so much Dr. Okun, and Thank You for your condolences, this is my father in law we are speaking about, it has been a longtime since his death, and my wife still cries everyday thinking she could have done more for her Father during his short hospital stay, so I pulled his records in hopes to decipher what happened so my wife might get some closure, out of the 29 drugs he was given during the 10 days, there were 17 major drug interactions, that were overridden on the hospitals MC-21 system haldol/parcopa being one of them and the last four days of his life they held his PD meds.

After you mentioned NMS I found this:
Neuroleptics (Includes Haldol) ↔ Nms
Severe Potential Hazard, High plausibility
Applies to: Neuroleptic Malignant Syndrome
The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.

And Haldol:
Haloperidol (Includes Haldol) ↔ Parkinsonism
Severe Potential Hazard, High plausibility
Applies to: Parkinsonism
The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects. The manufacturers of haloperidol consider its use to be contraindicated in patients with Parkinson's disease. Haloperidol is not for use in psychotic conditions related to dementia. Haloperidol may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions.
Esophageal dysmotility/aspiration: Antipsychotic use has been associated with esophageal dysmotility and aspiration; use with caution in patients at risk of pneumonia (ie, Alzheimer's disease). http://www.merck.com...haloperidol.htm

The FDA:
The FDA announced late yesterday that a new warning will be added to the schizophrenia drug Haldol, indicating that users could face an increased risk of sudden death from dangerous heart conditions.  Haldol side effects have been associated with sudden death, QT prolongation and Torsades de Pointes (TdP), especially when given through an IV or at higher dose Haloperidol is not approved for intravenous administration. 

Dysphagia:
Certain classes of drugs have been found to induce dysphagia in those who take them. Most commonly, these drugs belong to the anti-psychotic drugs, also known as neuroleptics. Anti-psychotic drugs are those that favorably modify "psychotic symptoms; categories include the phenothiazines, butyrophenones, thioxanthenes, dibenzodiazepines, diphenylbutylpiperidines, dihydroindolones, and dibenzoxazepines (Dorland, website.) The most common neuroleptic that has been reported to cause dysphagia is haloperidol (Haldol), which belongs to the butyrophenone group.

A Parkinson's specialist said this:
A prominent Toledo Doctor spoke and He urged EVERYONE diagnosed with Parkinsons Disease to contact EVERY doctor they see and add HALDOL (Haloperidol is a typical antipsychotic drug) to the list of meds they are allergic to. He said when asked what the side effects are, tell them “IT WILL KILL ME” and that should get medical staff attention. Said it ‘blocks’ the dopamine and the patient “FREEZES”, among other life-threatening reactions.”

I know you mentioned that Haldol could have Possibly caused my father in laws decline, I am starting to think it was more Probable than not.
I have read your comments on Haldol here on the site and can see why you don't use it in your patients, I hope my research will have expanded on it, and will help all the PD sufferers and their caregivers who frequent this site.

Again Dr. Okun, you are a Godsend and the community is lucky to have such a caring knowledgeable Doctor, needless to say the knowledge you share here is priceless in helping PD sufferers and their caregivers manage this complicated illness.

God Bless.........
Jim

#6 Dr. Okun

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Posted 11 March 2011 - 07:45 AM

Jim God Bless;

I will post so others can read.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#7 p_vier

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Posted 05 March 2012 - 09:53 PM

Thank You so much Dr. Okun, and Thank You for your condolences, this is my father in law we are speaking about, it has been a longtime since his death, and my wife still cries everyday thinking she could have done more for her Father during his short hospital stay, so I pulled his records in hopes to decipher what happened so my wife might get some closure, out of the 29 drugs he was given during the 10 days, there were 17 major drug interactions, that were overridden on the hospitals MC-21 system haldol/parcopa being one of them and the last four days of his life they held his PD meds.

After you mentioned NMS I found this:
Neuroleptics (Includes Haldol) ↔ Nms
Severe Potential Hazard, High plausibility
Applies to: Neuroleptic Malignant Syndrome
The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.

And Haldol:
Haloperidol (Includes Haldol) ↔ Parkinsonism
Severe Potential Hazard, High plausibility
Applies to: Parkinsonism
The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects. The manufacturers of haloperidol consider its use to be contraindicated in patients with Parkinson's disease. Haloperidol is not for use in psychotic conditions related to dementia. Haloperidol may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions.
Esophageal dysmotility/aspiration: Antipsychotic use has been associated with esophageal dysmotility and aspiration; use with caution in patients at risk of pneumonia (ie, Alzheimer's disease). http://www.merck.com...haloperidol.htm

The FDA:
The FDA announced late yesterday that a new warning will be added to the schizophrenia drug Haldol, indicating that users could face an increased risk of sudden death from dangerous heart conditions.  Haldol side effects have been associated with sudden death, QT prolongation and Torsades de Pointes (TdP), especially when given through an IV or at higher dose Haloperidol is not approved for intravenous administration. 

Dysphagia:
Certain classes of drugs have been found to induce dysphagia in those who take them. Most commonly, these drugs belong to the anti-psychotic drugs, also known as neuroleptics. Anti-psychotic drugs are those that favorably modify "psychotic symptoms; categories include the phenothiazines, butyrophenones, thioxanthenes, dibenzodiazepines, diphenylbutylpiperidines, dihydroindolones, and dibenzoxazepines (Dorland, website.) The most common neuroleptic that has been reported to cause dysphagia is haloperidol (Haldol), which belongs to the butyrophenone group.

A Parkinson's specialist said this:
A prominent Toledo Doctor spoke and He urged EVERYONE diagnosed with Parkinsons Disease to contact EVERY doctor they see and add HALDOL (Haloperidol is a typical antipsychotic drug) to the list of meds they are allergic to. He said when asked what the side effects are, tell them “IT WILL KILL ME” and that should get medical staff attention. Said it ‘blocks’ the dopamine and the patient “FREEZES”, among other life-threatening reactions.”

I know you mentioned that Haldol could have Possibly caused my father in laws decline, I am starting to think it was more Probable than not.
I have read your comments on Haldol here on the site and can see why you don't use it in your patients, I hope my research will have expanded on it, and will help all the PD sufferers and their caregivers who frequent this site.

Again Dr. Okun, you are a Godsend and the community is lucky to have such a caring knowledgeable Doctor, needless to say the knowledge you share here is priceless in helping PD sufferers and their caregivers manage this complicated illness.

God Bless.........
Jim


Jim,
My Dad had this precise thing happen to him when a doctor gave him haldol. My parents are in the middle of a lawsuit over the situation but we are having trouble finding definitive examples or specific symptoms that people with parkinsons get when administered haldol. Do you by any chance know the name of the doctor in Toledo for me to get in touch with about it?




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