COCHRANE CORNER
By Teresa L. Bryan, MSN, RN, FNP-BC
Editor’s note: This is a summary of a nursing care–related systematic review from the Cochrane Library.
Haloperidol vs. Low-Potency Antipsychotic Drugs for Schizophrenia REVIEW QUESTION
Is the high-potency antipsychotic drug haloperidol more effective than low-potency antipsychotic drugs?
TYPE OF REVIEW
This is a systematic review containing 17 randomized trials comparing the clinical efficacy of haloperidol with that of low-potency first-generation antipsychotic drugs in the treatment of schizophrenia and schizophrenia-like psychosis.
RELEVANCE FOR NURSING
Antipsychotic drugs are the principal treatment for schizophrenia and are classified as high potency or low potency. Low-potency antipsychotic drugs require higher doses to achieve the same therapeutic effect as high-potency antipsychotic drugs at lower doses. All antipsychotic drugs block the dopamine receptors in the brain. Low-potency first-generation antipsychotics are perceived to be less effective than high-potency antipsychotics. Both high-potency and low-potency antipsychotics differ in their adverse effects. High-potency antipsychotics are associated with extrapyramidal symptoms, whereas low-potency antipsychotics produce sedation as well as hypotension. When prescribing antipsychotic drugs, a careful balance must be achieved between their clinical effectiveness and their adverse effects.
CHARACTERISTICS OF THE EVIDENCE
Seventeen randomized trials were identified with a total of 877 participants (mean age, 39.1 years). All studies were short term, ranging from up to one month to three months. Criteria used to establish the diagnosis of schizophrenia or schizophrenia-like psychosis varied. In most studies, flexible doses of oral antipsychotics were used. Haloperidol doses ranged from 2 to 100 mg/day. Eight studies compared haloperidol with chlorpromazine, with doses between 50 and 1,800 mg/day. Levomepromazine in doses ranging from 50 to 379 mg/day was the comparator in two studies. One study compared haloperidol to mesoridazine in doses of 100 to 800 mg/day. Other comparators included 300 to 900 mg/day of perazine in two studies and thioridazine in doses of 60 to 800 mg/day in four. [email protected]
The primary outcome was the response to treatment as reported in each study. Other outcomes included leaving the study early, death, adverse effects, and quality of life. Sequence generation, allocation procedures, and blinding were poorly reported. No clear evidence was found to support that haloperidol was superior to low-potency first-generation antipsychotics in terms of clinical response. There was also no clear difference in the number of participants leaving the trials early because of adverse effects or inefficacy of treatment with either halpoperidol or low-potency antipsychotics. More participants from the low-potency antipsychotic groups experienced sedation, orthostasis problems, and weight gain. The haloperidol groups more frequently reported at least one movement disorder. No data were available concerning death or quality of life.
BEST PRACTICE RECOMMENDATIONS
Haloperidol and low-potency antipsychotics were approximately equal in clinical effectiveness. Sedation, orthostasis, and weight gain were more frequently reported in the low-potency groups, and movement disorders were more frequently reported in the haloperidol groups. Long-term adverse effects were not reported at all. Owing to the limited number of studies and participants, as well as the low quality of the studies, these results must be interpreted with caution.
RESEARCH RECOMMENDATIONS
The use of haloperidol or low-potency antipsychotics must be further evaluated. There is a need for more randomized clinical trials of longer duration to compare the drugs in terms of clinical effectiveness and other outcomes. ▼ Teresa L. Bryan is an assistant professor and coordinator of graduate programs at Alcorn State University, Natchez, MS, and a member of the Cochrane Nursing Care Field.
SOURCE DOCUMENT Tardy M, et al. Haloperidol versus low-potency first- generation antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2014;7:CD009268.
AJN ▼ July 2015
▼
Vol. 115, No. 7
21
By Teresa L. Bryan, MSN, RN, FNP-BC
Editor’s note: This is a summary of a nursing care–related systematic review from the Cochrane Library.
Haloperidol vs. Low-Potency Antipsychotic Drugs for Schizophrenia REVIEW QUESTION
Is the high-potency antipsychotic drug haloperidol more effective than low-potency antipsychotic drugs?
TYPE OF REVIEW
This is a systematic review containing 17 randomized trials comparing the clinical efficacy of haloperidol with that of low-potency first-generation antipsychotic drugs in the treatment of schizophrenia and schizophrenia-like psychosis.
RELEVANCE FOR NURSING
Antipsychotic drugs are the principal treatment for schizophrenia and are classified as high potency or low potency. Low-potency antipsychotic drugs require higher doses to achieve the same therapeutic effect as high-potency antipsychotic drugs at lower doses. All antipsychotic drugs block the dopamine receptors in the brain. Low-potency first-generation antipsychotics are perceived to be less effective than high-potency antipsychotics. Both high-potency and low-potency antipsychotics differ in their adverse effects. High-potency antipsychotics are associated with extrapyramidal symptoms, whereas low-potency antipsychotics produce sedation as well as hypotension. When prescribing antipsychotic drugs, a careful balance must be achieved between their clinical effectiveness and their adverse effects.
CHARACTERISTICS OF THE EVIDENCE
Seventeen randomized trials were identified with a total of 877 participants (mean age, 39.1 years). All studies were short term, ranging from up to one month to three months. Criteria used to establish the diagnosis of schizophrenia or schizophrenia-like psychosis varied. In most studies, flexible doses of oral antipsychotics were used. Haloperidol doses ranged from 2 to 100 mg/day. Eight studies compared haloperidol with chlorpromazine, with doses between 50 and 1,800 mg/day. Levomepromazine in doses ranging from 50 to 379 mg/day was the comparator in two studies. One study compared haloperidol to mesoridazine in doses of 100 to 800 mg/day. Other comparators included 300 to 900 mg/day of perazine in two studies and thioridazine in doses of 60 to 800 mg/day in four. [email protected]
The primary outcome was the response to treatment as reported in each study. Other outcomes included leaving the study early, death, adverse effects, and quality of life. Sequence generation, allocation procedures, and blinding were poorly reported. No clear evidence was found to support that haloperidol was superior to low-potency first-generation antipsychotics in terms of clinical response. There was also no clear difference in the number of participants leaving the trials early because of adverse effects or inefficacy of treatment with either halpoperidol or low-potency antipsychotics. More participants from the low-potency antipsychotic groups experienced sedation, orthostasis problems, and weight gain. The haloperidol groups more frequently reported at least one movement disorder. No data were available concerning death or quality of life.
BEST PRACTICE RECOMMENDATIONS
Haloperidol and low-potency antipsychotics were approximately equal in clinical effectiveness. Sedation, orthostasis, and weight gain were more frequently reported in the low-potency groups, and movement disorders were more frequently reported in the haloperidol groups. Long-term adverse effects were not reported at all. Owing to the limited number of studies and participants, as well as the low quality of the studies, these results must be interpreted with caution.
RESEARCH RECOMMENDATIONS
The use of haloperidol or low-potency antipsychotics must be further evaluated. There is a need for more randomized clinical trials of longer duration to compare the drugs in terms of clinical effectiveness and other outcomes. ▼ Teresa L. Bryan is an assistant professor and coordinator of graduate programs at Alcorn State University, Natchez, MS, and a member of the Cochrane Nursing Care Field.
SOURCE DOCUMENT Tardy M, et al. Haloperidol versus low-potency first- generation antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2014;7:CD009268.
AJN ▼ July 2015
▼
Vol. 115, No. 7
21
