Haloperidol: Extrapyramidal Effects, Tardive Dyskinesia, and Sedation Risks in Psychotic Disorders

Haloperidol is a widely used typical antipsychotic in the treatment of psychotic disorders. However, its use is associated with a range of side effects, particularly extrapyramidal effects (EPS), which can limit its tolerability and acceptance by patients. This article explores the side effects of haloperidol, with a particular focus on the risks of extrapyramidal effects, including tardive dyskinesia, and offers an evaluation based on recent scientific literature.

Delving into the Side Effects of Haloperidol

Haloperidol, like other typical antipsychotics, primarily acts as a dopamine D2 receptor antagonist. This action is effective in controlling psychotic symptoms but is also responsible for extrapyramidal side effects, which include parkinsonism, akathisia, acute dystonia, and tardive dyskinesia. A systematic comparative study has shown that haloperidol has a higher incidence of EPS compared to second-generation antipsychotics, such as olanzapine and risperidone [1].

Moreover, early response to treatment with haloperidol may predict the onset of EPS. One study found that early improvement in psychiatric symptoms is associated with a lower risk of developing EPS, suggesting that early monitoring may be key to minimizing these effects [2].

The risk of side effects may also be influenced by genetic factors. The CYP2D6*4 polymorphism, for example, affects the plasma concentration of haloperidol and, consequently, its safety profile. Patients with certain genetic variants may have a higher risk of adverse reactions [3].

Conclusions

The use of haloperidol in the treatment of psychotic disorders remains a valid option but requires careful consideration of extrapyramidal effects and other side effects, including sedation. Treatment choice should be individualized, taking into account early response to the medication and potential genetic factors that may influence patient tolerance. Ongoing research and clinical evaluation are essential to optimize the use of haloperidol and improve the quality of life for patients.

Referencias

• [1] Antipsychotic drugs and extrapyramidal side effects in first episode psychosis: a systematic review of head-head comparisons.
• [2] The Relationship Between Early Haloperidol Response and Associated Extrapyramidal Side Effects.
• [3] Association of CYP2D6*4 Polymorphism with the Steady-State Concentration of Haloperidol in Patients with Alcohol-Induced Psychotic Disorders.

Created 6/1/2025