Clozapine, olanzapine and, to a lesser extent, quetiapine may cause sedation, anticholinergic effects and orthostatic hypotension. Quetiapine has not been studied in the elderly. 18 How this drug compares with other newer antipsychotics remains to be established. 19 Risperidone is well tolerated, 18 and several studies have demonstrated its efficacy in the management of psychotic and aggressive symptoms in patients with dementia. 18 , 20 Risperidone, in dosages of to mg per day, has successfully alleviated behavioral disturbances in patients with Alzheimer's disease. 21 , 22 Clozapine is somewhat more difficult to use because of its association with agranulocytosis and the need for periodic monitoring of complete blood counts.
There are no well controlled studies with Haldol (haloperidol) in pregnant women. There are reports, however, of cases of limb malformations observed following maternal use of Haldol along with other drugs which have suspected teratogenic potential during the first trimester of pregnancy. Causal relationships were not established in these cases. Since such experience does not exclude the possibility of fetal damage due to Haldol, this drug should be used during pregnancy or in women likely to become pregnant only if the benefit clearly justifies a potential risk to the fetus.
Haloperidol use may lead to the development of symptoms that resemble Parkinson's disease, but that are not caused by Parkinson's. These symptoms may include a taut or mask-like expression on the face, drooling, tremors, pill-rolling motions in the hands, cogwheel rigidity (abnormal rigidity in muscles, characterized by jerky movements when the muscle is passively stretched), and a shuffling gait. Taking the anti-Parkinson drugs benztropine mesylate or trihexyphenidyl hydrochloride along with haloperidol help to control these symptoms. Medication to control Parkinsonian-like symptoms may have to be continued after haloperidol is stopped. This is due to different rates of elimination of these drugs from the body.