Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Can Haloperidol Cause Sudden Death?
Question: FOR Dr. Ilir Sharka ONLY
Hello Dr Sharka
I appreciate you helping me in the past when I had a cardiology question and am hoping you will be able to help now me with a different question.
I understand that haloperidol can cause sudden death through affecting the qt interval of the heart, however are there any other ways the drug can cause sudden death?
Many thanks
Hello Dr Sharka
I appreciate you helping me in the past when I had a cardiology question and am hoping you will be able to help now me with a different question.
I understand that haloperidol can cause sudden death through affecting the qt interval of the heart, however are there any other ways the drug can cause sudden death?
Many thanks
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome back again on HCM!
I agree with you that Haloperidol (like other anti-psychotic drugs) can cause QT interval prolongation, thus leading to increased risk for cardiac arrhythmia and even sudden death.
But, it can also cause a rare but very life-threatening complication which is called Neuroleptic malignant syndrome. This syndrome is more frequent in Haloperidol compared to other new generation anti-psychotics. It causes generalized rhabdomyolysis (muscle rupture) with persistent and resistant high fever with a high mortality. You should know that this adverse effects is often related to high doses of Haloperidol.
These are the two main causes of acute death from Haloperidol.
But, I would like to mention some other possible adverse effects which cause high morbidity and are difficult to treat:
- tardive dyskinezia, which are involuntary movements affecting mouth and limbs
- Parkinsonism, which is induced parkinson's syndrome related to this drug.
Both these adverse effects occur when Haloperidol is used for a long time and have a direct impact on the quality of life.
For the above reasons, I would recommend discussing with your doctor on other treatment options with less adverse effects (like new generation anti-psychotics), which are better tolerated when used for a long period of time.
Hope to have been helpful!
Feel free to ask me again whenever you need!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome back again on HCM!
I agree with you that Haloperidol (like other anti-psychotic drugs) can cause QT interval prolongation, thus leading to increased risk for cardiac arrhythmia and even sudden death.
But, it can also cause a rare but very life-threatening complication which is called Neuroleptic malignant syndrome. This syndrome is more frequent in Haloperidol compared to other new generation anti-psychotics. It causes generalized rhabdomyolysis (muscle rupture) with persistent and resistant high fever with a high mortality. You should know that this adverse effects is often related to high doses of Haloperidol.
These are the two main causes of acute death from Haloperidol.
But, I would like to mention some other possible adverse effects which cause high morbidity and are difficult to treat:
- tardive dyskinezia, which are involuntary movements affecting mouth and limbs
- Parkinsonism, which is induced parkinson's syndrome related to this drug.
Both these adverse effects occur when Haloperidol is used for a long time and have a direct impact on the quality of life.
For the above reasons, I would recommend discussing with your doctor on other treatment options with less adverse effects (like new generation anti-psychotics), which are better tolerated when used for a long period of time.
Hope to have been helpful!
Feel free to ask me again whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that answer.
Can you tell me what other causes of sudden death there are for the drug?
I am also interested in quetiapine, can you tell me all the causes of sudden death for that drug also?
Can you tell me what other causes of sudden death there are for the drug?
I am also interested in quetiapine, can you tell me all the causes of sudden death for that drug also?
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Regarding haloperidol, as I explained to you sudden death can be caused by life-threatinening cardiac arrhythmia, related to QT interval prolongation, which is a known adverse effect of this drug.
Malignant neuroleptic syndrome can lead to death, but more gradual than cardiac arrhythmia (death can occur withing some days from the beginning of the symptoms).
Regarding Quetiapine, the adverse effects are similar to haloperidol. It can cause QT prolongation in less than 1% of the patients, leading to cardiac arrhythmia with a high risk for sudden death.
From the other hand, it can cause other possible adverse effects such as pancreatitis, myocarditis and myocardiopathy and neutropenia, which are potential life-threatening medical conditions with a high rate of mortality, but do not cause sudden death.
Anyway, regarding QT prolongation and the risk of sudden cardiac death, I would explain that it is a known adverse effect of many anti-psychotics and antidepressants. But it is usually dose-related, which means that it is more evident when higher doses are used.
Besides, the risk of sudden cardiac death is related to significant QT prolongation and not to borderline QT interval.
That is why with a regular follow up with repeated ECG (every month), this adverse effect can be monitored and the drug can be stopped if there is evidence of QT prolongation, before causing severe QT prolongation. In such way the risk of sudden death would be almost insignificant with a good monitoring of ECG.
Hope to have clarified some of your uncertainties!
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Regarding haloperidol, as I explained to you sudden death can be caused by life-threatinening cardiac arrhythmia, related to QT interval prolongation, which is a known adverse effect of this drug.
Malignant neuroleptic syndrome can lead to death, but more gradual than cardiac arrhythmia (death can occur withing some days from the beginning of the symptoms).
Regarding Quetiapine, the adverse effects are similar to haloperidol. It can cause QT prolongation in less than 1% of the patients, leading to cardiac arrhythmia with a high risk for sudden death.
From the other hand, it can cause other possible adverse effects such as pancreatitis, myocarditis and myocardiopathy and neutropenia, which are potential life-threatening medical conditions with a high rate of mortality, but do not cause sudden death.
Anyway, regarding QT prolongation and the risk of sudden cardiac death, I would explain that it is a known adverse effect of many anti-psychotics and antidepressants. But it is usually dose-related, which means that it is more evident when higher doses are used.
Besides, the risk of sudden cardiac death is related to significant QT prolongation and not to borderline QT interval.
That is why with a regular follow up with repeated ECG (every month), this adverse effect can be monitored and the drug can be stopped if there is evidence of QT prolongation, before causing severe QT prolongation. In such way the risk of sudden death would be almost insignificant with a good monitoring of ECG.
Hope to have clarified some of your uncertainties!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that answer.
In rare instances, is it possible for haloperidol to cause a type of life threatening cardiac arrhythmia which is not caused by long qt syndrome? And what about other antipsychotics, can they do the same?
Also, when you look at the cardiac side effects of haloperidol on this webpage: https://www.drugs.com/sfx/haloperidol-side-effects.html, under the sub-heading of ‘Cardiovascular’, there are a number of types of life threatening cardiac arrhythmia, are these all caused by long qt syndrome or can they occur independently of the syndrome?
In rare instances, is it possible for haloperidol to cause a type of life threatening cardiac arrhythmia which is not caused by long qt syndrome? And what about other antipsychotics, can they do the same?
Also, when you look at the cardiac side effects of haloperidol on this webpage: https://www.drugs.com/sfx/haloperidol-side-effects.html, under the sub-heading of ‘Cardiovascular’, there are a number of types of life threatening cardiac arrhythmia, are these all caused by long qt syndrome or can they occur independently of the syndrome?
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I followed the link that you mentioned, and would like to explain that these complications are mainly related to the QT prolongation. They are different types of cardiac arrhythmia.
But, as I already explained this is a known adverse effect of many anti-psychotics and anti-depressants.
Anyway, these are really rare complications and can be monitored by repeated ECG.
But, when choosing the anti-psychotic, I would recommend you to consider also the other adverse effects in the central nervous system, such as tardive dyskinesia (which can have a direct impact on your quality of life) when Haloperidol is used in high doses for a long time.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I followed the link that you mentioned, and would like to explain that these complications are mainly related to the QT prolongation. They are different types of cardiac arrhythmia.
But, as I already explained this is a known adverse effect of many anti-psychotics and anti-depressants.
Anyway, these are really rare complications and can be monitored by repeated ECG.
But, when choosing the anti-psychotic, I would recommend you to consider also the other adverse effects in the central nervous system, such as tardive dyskinesia (which can have a direct impact on your quality of life) when Haloperidol is used in high doses for a long time.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that answer.
Bringing in the webpage I think I have confused things. Let's completely forget about the webpage for the time being and just address the first question that I posed, if that is okay with you?
The first question was: "In rare instances, is it possible for haloperidol to cause a type of life threatening cardiac arrhythmia which is not caused by long qt syndrome? And what about other antipsychotics, can they do the same?"
Bringing in the webpage I think I have confused things. Let's completely forget about the webpage for the time being and just address the first question that I posed, if that is okay with you?
The first question was: "In rare instances, is it possible for haloperidol to cause a type of life threatening cardiac arrhythmia which is not caused by long qt syndrome? And what about other antipsychotics, can they do the same?"
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Regarding your concern, you should know that QT prolongation is the only mechanism which leads to cardiac arrhythmia, when taking haloperidol or other antipsychotics.
All the types of arrhythmia caused by these drugs are related to QT interval prolongation.
Hope to have helped you clarify these issues!
If you have any other questions, please do not hesitate to ask me again!
Regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Regarding your concern, you should know that QT prolongation is the only mechanism which leads to cardiac arrhythmia, when taking haloperidol or other antipsychotics.
All the types of arrhythmia caused by these drugs are related to QT interval prolongation.
Hope to have helped you clarify these issues!
If you have any other questions, please do not hesitate to ask me again!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that answer.
Your help in this matter is very much appreciated!!
To get back to the webpage that we spoke about earlier, to be clear are you saying that the following conditions taken from the webpage: “Torsade de pointes, ventricular arrhythmias/fibrillation/tachycardia”, can occur when taking haloperidol ONLY as a result of an individual first developing long qt syndrome?
Your help in this matter is very much appreciated!!
To get back to the webpage that we spoke about earlier, to be clear are you saying that the following conditions taken from the webpage: “Torsade de pointes, ventricular arrhythmias/fibrillation/tachycardia”, can occur when taking haloperidol ONLY as a result of an individual first developing long qt syndrome?
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Yes, all these types of cardiac arrhythmia are related to QT interval prolongation in this case. This is the main mechanism of all these types of arrhythmia.
Hope to have been helpful!
I remain at your disposal for any other questions!
Wishing all the best,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Yes, all these types of cardiac arrhythmia are related to QT interval prolongation in this case. This is the main mechanism of all these types of arrhythmia.
Hope to have been helpful!
I remain at your disposal for any other questions!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer.
Other conditions listed under the cardiac section on the webpage we’ve spoken about were: “extrasystoles, peripheral edema, venous thromboembolism, deep vein thrombosis”. I believe some of these conditions can cause also sudden death. I am 26 and have a normal and healthy heart (except for palpitations sometimes). Do I have to have to accept the risk that I might develop these conditions as well or am I too young?
Also, can life threatening cardiac arrhythmia and neuroleptic malignant syndrome occur during the first day of use of haloperidol or does it take a while for those things to become possible? And if it does take a while, can you give me a rough idea of how long? Also if neuroleptic malignant syndrome is going to happen is it going to happen on the first day of use of haloperidol much like a nut allergy or can it occur at any point in time?
Other conditions listed under the cardiac section on the webpage we’ve spoken about were: “extrasystoles, peripheral edema, venous thromboembolism, deep vein thrombosis”. I believe some of these conditions can cause also sudden death. I am 26 and have a normal and healthy heart (except for palpitations sometimes). Do I have to have to accept the risk that I might develop these conditions as well or am I too young?
Also, can life threatening cardiac arrhythmia and neuroleptic malignant syndrome occur during the first day of use of haloperidol or does it take a while for those things to become possible? And if it does take a while, can you give me a rough idea of how long? Also if neuroleptic malignant syndrome is going to happen is it going to happen on the first day of use of haloperidol much like a nut allergy or can it occur at any point in time?
Brief Answer:
My answer as follows:
Detailed Answer:
I understand your concern and would like to explain that extrasystoles (also called ectopic heart beats)are a type of benign arrhythmia, related to QT prolongation.
Peripheral edema means leg or hand swelling and is caused by increased fluid retention. This is not a life-threatening medical condition.
Deep vein thrombosis and venous thromboembolism indicate the formation of blood clots in the venous system. Even this condition does not cause sudden death, although it is a serious medical condition, caused by the changes in blood chemistry and the increased coagulability.
So, none of the above disorders can lead to acute death.
Regarding Neuroleptic malignant syndrome, you should know that it is a idiosyncratic reaction to haloperidol (similar to allergic reactions). It can occur in the first days from starting haloperidol or when there is a increase in the dose. Unfortunately, we can not predict if it will happen in the first day or after some days.
Anyway, it is associated to high fever, confusion, generalized muscular pain.
So, it has a very typical symptomatogy and upon noticing the first signs the patient is transferred on the ICU unit for specialized treatment.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
My answer as follows:
Detailed Answer:
I understand your concern and would like to explain that extrasystoles (also called ectopic heart beats)are a type of benign arrhythmia, related to QT prolongation.
Peripheral edema means leg or hand swelling and is caused by increased fluid retention. This is not a life-threatening medical condition.
Deep vein thrombosis and venous thromboembolism indicate the formation of blood clots in the venous system. Even this condition does not cause sudden death, although it is a serious medical condition, caused by the changes in blood chemistry and the increased coagulability.
So, none of the above disorders can lead to acute death.
Regarding Neuroleptic malignant syndrome, you should know that it is a idiosyncratic reaction to haloperidol (similar to allergic reactions). It can occur in the first days from starting haloperidol or when there is a increase in the dose. Unfortunately, we can not predict if it will happen in the first day or after some days.
Anyway, it is associated to high fever, confusion, generalized muscular pain.
So, it has a very typical symptomatogy and upon noticing the first signs the patient is transferred on the ICU unit for specialized treatment.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
