04. Interpretation of Plasma Haloperidol Levels
Key Points
- The clinical data for haloperidol indicates that many patients tolerate levels that should exceed the 80% D2 occupancy threshold.
- The minimum threshold for response is 3 – 5 ng/mL.
- Very few patients will tolerate levels above 20 ng/mL.
- 30 ng/mL represents the point of futility beyond which one is unlikely to find greater efficacy, even if tolerated.
- If high plasma levels are obtained, one should not reflexively reduce the dose drastically.
- Instead, document that the patient appears to be tolerating this current level, and then order a repeat level.
- If it remains high, and there is some doubt about whether the patient requires this level, the dose should be decreased by no more than 10% per month to prevent rebound psychosis.
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