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Haloperidol

Also indexed as: Haldol®

Haloperidol is a drug used to treat people with psychotic disorders, including schizophrenia.

Interactions with Dietary Supplements

Glycine
Two double-blind studies have found that 0.4–0.8 mg/kg body weight per day of glycine can reduce the so-called negative symptoms of schizophrenia when combined with haloperidol and related drugs.1 2 Negative symptoms include reduced emotional expression or general activity. The action of glycine in combination with the drugs was greater than the drugs alone, suggesting a synergistic action. Another double-blind study using approximately half the amount in the positive studies could not find any benefit from adding glycine to antipsychotic drug therapy.3 Patients with low blood levels of glycine appeared to improve the most when given glycine in addition to their antipsychotic drugs.4 No side effects were noticed in these studies, even when more than 30 grams of glycine were given daily.

Iron
Haloperidol may cause decreased blood levels of iron.5 The importance of this interaction remains unclear. Iron should not be supplemented unless a deficiency is diagnosed.

Potassium
Haloperidol may cause hyperkalemia (high blood levels of potassium) or hypokalemia (low blood levels of potassium).6 The incidence and severity of these changes remains unclear. Serum potassium can be measured by any doctor.

Vitamin E
Haloperidol and related antipsychotic drugs can cause a movement disorder called tardive dyskinesia. Several double-blind studies suggest that vitamin E may be beneficial for treatment of tardive dyskinesia.7 Taking the large amount of 1,600 IU per day of vitamin E simultaneously with antipsychotic drugs has also been shown to lessen symptoms of tardive dyskinesia.8 It is unknown if combining vitamin E with haloperidol could prevent tardive dyskinesia.

Sodium
Haloperidol may cause hyponatremia (low blood levels of sodium).9 The incidence and severity of these changes remains unclear.

Interactions with Herbs

Milk thistle  (Silybum marianum)
Haloperidol may cause liver damage. A double-blind study in 60 women treated with drugs such as haloperidol were given 800 mg per day silymarin extract made from milk thistle.10 Test subjects who were given silymarin experienced a significant decrease in free radical levels, unlike those given placebo.

Interactions with Foods and Other Compounds

Coffee and Tea
Coffee and tea are reported to cause precipitation of haloperidol in the test tube.11 If this interaction happens in people, it would reduce the amount of haloperidol absorbed and the effectiveness of therapy. People taking haloperidol may avoid this possible interaction by taking haloperidol one hour before or two hours after drinking coffee or tea.

Alcohol
Haloperidol may cause drowsiness.12 Alcohol may compound this drowsiness and increase the risk of accidents during activities requiring alertness. People should avoid alcohol-containing products during haloperidol therapy.

Summary of Interactions for Haloperidol

Depletion or interference Iron*
Sodium*
Adverse interaction None known
Side effect reduction/prevention Milk thistle*
Vitamin E
Supportive interaction Glycine
Reduced drug absorption/bioavailability Tea and coffee*
Other (see text) Potassium

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Heresco-Levy U, Javitt DC, Ermilov M, et al. Double-blind, placebo-controlled, crossover trial of glycine adjuvant therapy for treatment-resistant schizophrenia. Br J Psychiatry 1996;169:610–7.

2. Javitt DC, Zylberman I, Zukin SR, et al. Amelioration of negative symptoms in schizophrenia by glycine. Am J Psychiatry 1994;151:1234–6.

3. Potkin SG, Costa J, Roy S, et al. Glycine in treatment of schizophrenia—theory and preliminary results. In: Meltzer HY (ed). Novel Antipsychotic Drugs. New York: Raven Press, 1990:179–88.

4. Heresco-Levy U, Javitt DC, Ermilov M, et al. Double-blind, placebo-controlled, crossover trial of glycine adjuvant therapy for treatment-resistant schizophrenia. Br J Psychiatry 1996;169:610–7.

5. Threlkeld DS, ed. Central Nervous System Drugs, Antipsychotic Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, May 1998, 266k–6m.

6. Threlkeld DS, ed. Central Nervous System Drugs, Antipsychotic Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, May 1998, 266k–6m.

7. Adler LA, Peselow E, Rotrosen J, et al. Vitamin E treatment of tardive dyskinesia. Am J Psychiatry 1993;150:1405–7.

8. Adler LA, Edson R, Lavori P, et al. Long-term treatment effects of vitamin E for tardive dyskinesia. Biol Psychiatry 1998;43:868–72.

9. Threlkeld DS, ed. Central Nervous System Drugs, Antipsychotic Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, May 1998, 266k–6m.

10. Palasciano G, Portincasa P, Palmieri V, et al. The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs. Curr Ther Res 1994;55:537–45.

11. Lasswell WL Jr, Weber SS, Wilkins JM. In vitro interaction of neuroleptics and tricyclic antidepressants with coffee, tea, and gallotannic acid. J Pharm Sci 1984;73:1056–8.

12. Threlkeld DS, ed. Central Nervous System Drugs, Antipsychotic Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, May 1998, 266k–6m.