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Serum Haloperidol Levels in Older Psychotic Patients

From the Department of Psychiatry, University of California, San Diego, School of Medicine and the San Diego Veterans Affairs Medical Center.

The authors measured serum levels of haloperidol (HL) in outpatients ages 45–83 years with psychosis treated with HL for at least 1 month. Blood was collected from 32 patients with either schizophrenia (n = 23) or Alzheimer's disease (AD) (n = 9). HL daily dose was greater in patients with schizophrenia (median age, 59) than in AD patients (median age, 80) (P < 0.0005), but no significant group differences in HL serum concentrations were observed. In the total sample, age correlated negatively with HL dose (P < 0.001) and positively with the ratio of serum HL level/dose (P < 0.05). The ratio of HL level/dose was higher in the elderly AD patients than in younger subjects with schizophrenia (P < 0.005). Serum HL levels were much lower than those reported in younger schizophrenia patients, but comparable to those reported in elderly patients with AD. Aging-related and disease-associated pharmacokinetic and pharmacodynamic changes may reduce the need for higher neuroleptic doses as well as higher blood levels in older patients.