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Haloperidol and reduced haloperidol in saliva and blood
M W Dysken1, S B Johnson, L Holden
1Minneapolis Veterans Administration Medical Center, Minnesota 55417.
Insights
Saliva measurements of haloperidol (H) and reduced haloperidol (RH) show promise as an alternative to blood tests for monitoring patient treatment. Whole saliva measures correlated better with blood levels than parotid saliva, suggesting a practical application in clinical settings.
Area of Science:
- Pharmacology
- Clinical Chemistry
- Psychiatry
Background:
- Haloperidol is a widely used antipsychotic medication.
- Monitoring therapeutic drug levels is crucial for effective treatment and minimizing side effects.
- Current monitoring relies on plasma concentrations, which can be invasive.
Purpose of the Study:
- To investigate the utility of saliva as a non-invasive matrix for monitoring haloperidol and reduced haloperidol concentrations.
- To compare the correlation between saliva haloperidol levels and blood haloperidol levels.
Main Methods:
- Collected whole and parotid saliva samples, along with blood samples, from 18 outpatients on maintenance haloperidol therapy.
- Measured steady-state concentrations of haloperidol (H) and reduced haloperidol (RH) in plasma, red blood cells, and saliva.
- Calculated correlation coefficients between saliva concentrations and blood levels, and between saliva secretion rates and blood levels.
Main Results:
- Correlations between whole saliva measures (H and RH) and blood concentrations were higher than those for parotid saliva.
- In one instance, whole saliva measures demonstrated a statistically significant correlation with blood levels.
- Saliva secretion rate had a minimal impact on improving correlations with saliva concentration.
Conclusions:
- Saliva measures of haloperidol and reduced haloperidol are potentially useful and non-invasive alternatives to plasma concentrations for monitoring maintenance therapy.
- Whole saliva appears to be a more reliable indicator than parotid saliva for this purpose.
Abstract:
A total of 18 outpatients (17 male, 1 female) ranging in age from 36-66 years old were on a constant dosage of haloperidol in equally divided doses at 9:00 a.m. and 9:00 p.m. for at least 1 month. DSM-III-R diagnoses included schizophrenia (N = 9), schizoaffective disorder (N = 3), bipolar disorder (N = 4), organic mental disorder (N = 1), and delusional disorder (N = 1). Blood samples for steady-state concentrations of plasma and red blood cell haloperidol (H) and reduced haloperidol (RH) were drawn at 9:00 a.m. (12 hr trough). The haloperidol dosage was held at 9:00 a.m. until samples of whole saliva and parotid saliva could be collected for flow rates and concentrations of H and RH. Haloperidol dosages ranged from 1 mg/day to 60 mg/day (mean 11 +/- 15). Correlation coefficients were calculated for saliva concentrations versus blood levels and for saliva secretion rates versus blood levels. The correlations between whole saliva measures and blood concentrations were all higher than the correlations between parotid saliva measures and blood concentrations. In one case the higher correlation reached statistical significance. There was only one case in which substitution of saliva secretion rate improved the correlation between measures with saliva concentration. Our findings suggest that saliva measures of H and RH are useful alternatives to plasma concentrations in monitoring maintenance haloperidol treatment.