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Haloperidol

Antipsychotic Agents
CATEGORIES

Antipsychotic Agents, Butyrophenones, Antidyskinetics


ALIASES

Haldol, Haldol Depot, Haldol®, Haldol® Depot, Haldol®-Janssen, Haloperidol WZF, Haloperidol ratiopharm, Haloperidol-Grindeks, Haloperidol-neuraxpharm, Haloperidol-ratiopharm®, Serenase, Linton, Peluces, Serenace, Sigaperidol


SUBSTANCES

haloperidol, haloperidol decanoate


ENVIRONMENTAL CONCERN: HIGH
A phenyl-piperidinyl-butyrophenone that is used primarily to treat schizophrenia and other psychoses. It is also used in schizoaffective disorder, delusional disorders, ballism, and tourette syndrome (a drug of choice) and occasionally as adjunctive therapy in mental retardation and the chorea of huntington disease. It is a potent antiemetic and is used in the treatment of intractable hiccups. (From AMA Drug Evaluations Annual, 1994, p279)

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HIGH
In Sweden haloperidol has been reported in wild fish and treated wastewater exposed fish at levels around therapeutic concentrations in humans.This is supported by the fat solubility of the substance and measured concentrations in surface waters. Mechanism-based efficacy data is lacking.

Haloperidol is included in the Stockholm County Council's table of pharmaceuticals with a negative environmental impact according to the environmental programme 2017-2021. Haloperidol has been detected in treated wastewater and fish in Stockholm County in the last five years (2012-2016).

Suggestions on how to reduce the release of haloperidol
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert advice. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise List. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.

Concrete proposal for haloperidol:
• Haloperidol is not recommended in the Wise List.
• An option for introduction into patients with schizophrenia may be aripiprazole (recommended in the Wise List and is better from an environmental point of view than haloperidol).

The risk classification insignificant, according to Fass.se, is based on total sold amount (kg) of haloperidol in Sweden during the year 2013 and the toxicity of the substance, i.e. consideration has not been given to measured levels in the environment.

REFERENCES

  1. Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
  2. IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3. Pharmaceuticals.
  3. IVL Swedish Environmental Research Institute Ltd Fick J, Lindberg RH, Fång J, Magnér J, Kaj L, Brorström-Lundén E. Screening 2014. Analysis of pharmaceuticals and hormones in samples from WWTPs and receiving waters. Rapport C 135.
  4. Furuhagen S, Liewenborg B, Breitholtz M, Gorokhova E. Feeding activity and xenobiotics modulate oxidative status in Daphnia magna: implications for ecotoxicological testing. Environ Sci Technol. 2014;48:12886-92.
  5. Fick J, Lindberg RH, Tysklind M, Larsson DG. Predicted critical environmental concentrations for 500 pharmaceuticals. Regul Toxicol Pharmacol. 2010;58:516-23.
  6. SLL. Sammanställning av läkemedelsprovtagningar - Bearbetning av regional försäljningsstatistik av läkemedel samt datamaterial från Stockholms läns landstings mätprogram för läkemedelssubstanser i vattenmiljö, 2012–2016.
  7. Stockholms läns landsting. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för SLL:s miljöprogram 2017–2021.
  8. Fass.se för vårdpersonal
  9. Socialstyrelsen. Statistikdatabas för läkemedel.
  10. Stockholms läns landsting. Janusinfo: Läkemedelsuppföljning