Haldol (haloperidol) vs. Abilify (aripiprazole)

• Haloperidol and Abilify (aripiprazole) are antipsychotic medications used to treat schizophrenia and Tourette's syndrome.
• Haloperidol is also used to treat acute psychosis.
• Abilify is also used to treat bipolar disorder, irritability associated with autistic disorder, and it is used with other medications to treat major depression in adults.
• A brand name for haloperidol is Haldol.
• Side effects of haloperidol and Abilify that are similar include nausea, weight gain, insomnia, vomiting, and constipation.
• Side effects of haloperidol that are different from Abilify include extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes; muscle stiffness, restlessness, Parkinsonism), dizziness, hyperactivity, tiredness, sedation, erectile dysfunction, menstrual irregularities, swelling of breast tissue in males (gynecomastia), dry mouth, and dizziness on standing during the first few weeks of treatment.
• Side effects of Abilify that are different from haloperidol include anxiety, blurred vision, cough, headache, lightheadedness, rash, restlessness, runny nose, sleepiness, tremors, and weakness.
• Do not stop using haloperidol or Abilify suddenly, or you could have unpleasant withdrawal symptoms.

Haloperidol is an antipsychotic drug used to treat schizophrenia, acute psychosis, and for treatment of tics and vocal utterances of Tourette's syndrome. Haloperidol interferes with the effects of neurotransmitters in the brain by blocking receptors for the neurotransmitters (specifically the dopamine and serotonin type 2 receptors) on the nerves. As a result, the nerves are not "activated" by the neurotransmitters released by other nerves.

Abilify (aripiprazole) is an anti-psychotic medicine used to treat schizophrenia, bipolar disorder, irritability associated with autistic disorder, and Tourette's disorder. It also is used with other medications for the treatment of major depression in adults. The exact mechanism of action of Abilify is unknown. Like other anti-psychotics, it blocks receptors on nerves in the brain for several neurotransmitters. It is thought that its beneficial effect is due to its effects on dopamine and serotonin receptors. Its effects on these receptors are complex, involving stimulation of the receptors but to a lesser degree than the naturally-occurring neurotransmitters (a process called partial agonism).

Haloperidol

The most common side effects associated with Haldol are:

• extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes, muscle stiffness, akathisia, Parkinsonism),
• dizziness,
• hyperactivity,
• tiredness, and
• nausea.

Other important side effects are:

• sedation,
• weight gain,
• erectile dysfunction,
• menstrual irregularities,
• insomnia,
• gynecomastia,
• dry mouth,
• vomiting, and
• constipation

Haldol may cause a condition called "orthostatic hypotension" during the early phase of treatment (first week or two). Orthostatic hypotension causes patients to become dizzy upon arising from a lying or sitting position because of a drop in blood pressure.

Haldol also may cause abnormal heart beats, sudden death, seizures, decreases in red and white blood cells, and withdrawal symptoms.

Elderly patients with dementia-related psychosis and treated with antipsychotic drugs such as Haldol are at an increased risk of death.

Abilify

WARNINGS

• Long-term use of aripiprazole may lead to a potentially irreversible condition called tardive dyskinesia (involuntary movements of the jaw, lips, and tongue).
• A potentially fatal complex referred to as neuroleptic malignant syndrome has been reported with anti-psychotic drugs, including Abilify. Patients who develop this syndrome may have:
  • High fevers
  • Muscle rigidity
  • Altered mental status
  • Irregular pulse or blood pressure
  • Rapid heart rate
  • Excessive sweating
  • Heart arrhythmias
• All atypical antipsychotic drugs have been associated with metabolic changes such as hyperglycemia, diabetes mellitus, dyslipidemia, and weight gain. Serious cases of hyperglycemia leading to coma or death have been reported in patients treated with atypical antipsychotics. Although there is no clear link between aripiprazole and diabetes, patients should be tested during treatment for elevated blood-sugars. Additionally, patients with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during medical treatment should be tested for diabetes.
• Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death and Abilify should not be used for this indication. Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of this medicine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on medical therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Some of the most common side effects include:

• Anxiety
• Blurred vision
• Constipation
• Cough
• Headache
• Insomnia
• Lightheadedness
• Nausea
• Rash
• Restlessness
• Runny nose
• Sleepiness
• Tremors
• Vomiting
• Weakness
• Weight gain

Haloperidol

• This dose for this medication usually is once a day.
• The usual adult starting oral dose for patients with schizophrenia or bipolar disorder is 10 to 15 mg once daily. The dose may be increased over time up to 30 mg daily to achieve the desired effect.
• The recommended dose for patients with Tourette's disorder is 5 to 20 mg once daily.

Abilify

• The recommended oral dose for schizophrenia is 0.5-5 mg two or three times daily up to a maximum dose of 30 mg daily. The lactate solution dose is 2-5 mg every 4-8 hours as needed by intramuscular injection. The lactate solution may also be administered by intravenous injection at 1-2 mg every 2-4 hours and titrated to effect. The maximum single injection dose is 50 mg and the maximum daily dose is 500 mg daily. The dose for the decanoate solution is 10-20 times the daily oral dose once monthly by intramuscular injection. The decanoate solution should not be administered intravenously.
• The recommended dose for treating Tourette's syndrome is 0.5-5 mg orally two or three times daily.

Haloperidol

Haldol causes sedation, and sedation may be greater if Haldol is taken with alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs for example:

• diazepam (Valium)
• lorazepam (Ativan)
• clonazepam (Klonopin)
• alprazolam (Xanax)

The narcotic class of pain medications and its derivatives for example:

• oxycodone and acetaminophen (Percocet)
• hydrocodone/acetaminophen (Vicodin)
• Dilaudid
• Codeine,
• propoxyphene (Darvon)

The tricyclic class of antidepressants for example:

• amitriptyline (Elavil, Endep)
• imipramine (Tofranil)
• desipramine (Norpramin)

Some antihistamines for example:

• hydroxyzine (Atarax, Vistaril)
• diphenhydramine (Benadryl)
• Tavist

Certain antihypertensive medications for example:

• clonidine (Catapres)
• propranolol (Inderal)

Carbamazepine (Tegretol) may increase the elimination of Haldol, rendering the Haldol less effective. Rifampin (Rifadin) may decrease the elimination of Haldol, increasing the risk of side effects from Haldol.

Abilify

• Carbamazepine (Tegretol) can markedly decrease the amount of Abilify in the body by increasing the rate at which the body's enzymes (particularly the liver enzyme, CYP3A4) degrade it. The manufacturer recommends that patients on this drug who are started on carbamazepine double their dose of Abilify, under their doctor's supervision. Other drugs that can promote the activity of CYP3A4 and decrease the body's levels of Abilify are phenytoin (Dilantin), rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate), and phenobarbital.
• Ketoconazole (Nizoral) can increase the amount of aripiprazole in the body by blocking CYP3A4. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during ketoconazole therapy. Many other drugs also are known to block CYP3A4 and potentially could increase the levels of aripiprazole, but their actual effects on aripiprazole levels have not been studied. Such drugs include:
  • itraconazole (Sporanox)
  • fluconazole (Diflucan)
  • voriconazole (Vfend)
  • cimetidine (Tagamet)
  • verapamil (Calan, Isoptin)
  • diltiazem (Cardizem, Dilacor)
  • erythromycin clarithromycin (Biaxin)
  • nefazodone (Serzone)
  • ritonavir (Norvir)
  • saquinavir (Invirase)
  • nelfinavir (Viracept)
  • indinavir (Crixivan)
  • Grapefruit juice
• Quinidine (Quinaglute, Quinidex) inhibits another liver enzyme known as CYP2D6 that also breaks down aripiprazole and can increase the amount of aripiprazole in the body. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during quinidine therapy. Other medicines that block CYP2D6 include fluoxetine (Prozac) and paroxetine (Paxil).
• Alpha-1 receptor blockers [doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin)], used for control of blood pressure and prostatic enlargement, may increase the chance of hypotension (unusually low blood pressure).

Haloperidol

• Neonates exposed to antipsychotics during the 3rd trimester of pregnancy may develop withdrawal symptoms and extrapyramidal symptoms.
• Haldol is secreted into breast milk. It should not be used while breast feeding.

Abilify

• Aripiprazole has not been adequately studied during pregnancy. Neonates exposed to antipsychotic drugs in the third trimester may experience withdrawal symptoms and other side effects. Your doctor or other healthcare provider may choose to use this medication if he or she feels that its benefits outweigh this potential concern.
• It is not known if this medicine is excreted in breast milk; however, since most medicines are excreted in breast milk, doctors and other health care professionals recommend that women should not breastfeed their infant/baby while taking Abilify.