Haloperidol의 올바른 투여, 정맥주사 vs 근육주사

Haloperidol, IM or IV? QT연장 부작용

 

성분명	Haloperidol
상품명	할로페리돌 주 5 MG/1 ML

 

페리돌 주 국내 허가사항

1. 정신분열증(조현병), 제1형 양극성 장애와 관련된 조증삽화, 정신병적 장애의 증상, 투렛증후군(Gilles de la Tourette's syndrome) : 이 약으로서 1일 6-15㎎을 분할 근육주사하며 가능한 빨리 경구 투여로 대치한다. 연령, 증상에 따라 적절히 증감한다
2. 구토 : 할로페리돌로서 1회 2.5-5mg을 근육주사한다.

Haloperidol의 Lexicomp

Lexicomp상에서도 haloperidol의 IV 투여는 off-label이다.

 

Haloperidol 염 차이

유통되고 있는 haloperidol의 종류는 2 종류이다.

성분명	특징
haloperidol lactate	일반적으로 5mg/1mL lactate는 첨가제로 함유되어 있음. IM lactate (prompt-acting) 2-5 mg q4-8hr PRN; may require q1hr in acute agitation; not to exceed 20 mg/day IV (Off-label) May be needed for ICU delirium; use only haloperidol lactate for IV administration; do not use haloperidol decanoate 2-10 mg initially, depending on degree of agitation; if response inadequate, may repeat bolus q15-30min, sequentially doubling initial bolus dose; when calm achieved, administer 25% of last bolus dose q6hr; taper dose after patient is controlled Monitor ECG and QT interval (QT prolongation may occur with cumulative doses ≥35 mg; torsades de pointes reported with single doses ≥20 mg)
haloperidol decanoate	상품명 : 할돌데카노아스주사 Haldol Decanoate Injection 70.52mg/mL (as haloperidol 50mg/mL) depot형식 정신병에 대한 유지요법 반드시 IM 한다. Initial: IM dose 10-20 times daily PO dose administered monthly; not to exceed 100 mg; if conversion requires initial dose >100 mg, administer in 2 injections (eg, 100 mg initially, then remainder in 3-7 days) Maintenance: Monthly dose 10-15 times daily PO dos 투여간격 : 일반적으로 4주간

 

Haloperidol의 IV시 예상되는 ADR

☞ Altered cardiac conduction :

Cases of sudden death, QT prolongation, and torsades de pointes have been reported with haloperidol use

risk may be increased with doses exceeding recommendations and/or intravenous administration (off-label route) of intramuscular lactate injection. = 특히 IM 제형으로 나온 것을 IV로 투여하였을 때 and/or 고용량 투여시 risk ▲

Use with caution or avoid use in patients with electrolyte abnormalities (eg, hypokalemia, hypomagnesemia), hypothyroidism, familial long QT syndrome, concomitant medications which may augment QT prolongation, or any underlying cardiac abnormality which may also potentiate risk.

= 특히 전해질 불균형일 때 risk가 커짐!!

Prior to initiation of intravenous therapy, obtain a baseline ECG. Consider continuous ECG monitoring, especially if the patient has risk factors for QTc prolongation, the baseline ECG reveals a prolonged QTc, or cumulative doses of ≥2 mg are needed.

= IV투여가 꼭 필요한 상황이라면, baseline ECG를 체크한 후, 투여 후에도 계속 monitoring 필요!!

Monitor electrolyte concentrations throughout therapy.

If the baseline QTc interval increases by 20% to 25%, increases >500 msec, or if T-waves flatten or U-waves develop on the ECG, reduce the dosage or consider alternative therapy.

 

할로페리돌 허가사항_경고

 

reference : 

(1) lexicomp

(2) medscape

(3) KIMS

(4) 의약품안전나라